title: Transient severe tricuspid regurgitation after transplantation of an extremely oversized donor heart in a child-Does size matter? A case report.
abstract: In pediatric heart transplantation, the size of the donor organ is an important criterion for organ allocation. Oversized donor hearts are often accepted with good results, but some complications in relation to a high donor-recipient ratio have been described. Our patient was transplanted for progressive heart failure in dilated cardiomyopathy. The donor-to-recipient weight ratio was 3 (donor weight 65 kg, recipient weight 22 kg). The intra-operative echocardiography before chest closure showed excellent cardiac function, no tricuspid valve regurgitation, and a normal central venous pressure. After chest closure, central venous pressure increased substantially and echocardiography revealed a severe tricuspid insufficiency. As other reasons for right ventricular dysfunction, that is, myocardial ischemia, pulmonary hypertension, and rejection, were excluded, we assumed that the insufficiency was caused by an alteration of the right ventricular geometry. After 1 week, the valve insufficiency regressed to a minimal degree. In pediatric heart transplant patients with a high donor-to-recipient weight ratio, the outlined complication may occur. If other reasons for right ventricular heart failure can be ruled out, this entity is most likely caused by an acute and transient alteration of the right ventricular geometry that may disappear over time.
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Birnbaum
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: S M
authors.initials: SM
authors.lastname: Ulrich
authors.affiliation: Department of Cardiac Surgery, University Hospital, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Schramm
authors.affiliation: Department of Cardiac Surgery, University Hospital, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Hagl
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Lehner
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Fischer
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: N A
authors.initials: NA
authors.lastname: Haas
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Heineking
mesh_terms: D001835:Body Weight; D002311:Cardiomyopathy, Dilated / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000033:anatomy & histology*; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D009929:Organ Size; D011184:Postoperative Period; D014019:Tissue Donors; D014261:Tricuspid Valve / Q000503:physiopathology; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000209:etiology*
keywords: organ size mismatch; oversized heart; pediatric heart transplantation; tricuspid regurgitation