HETEROTOPIC HEART-TRANSPLANTATION FOR ELEVATED PULMONARY VASCULAR-RESISTANCE IN PEDIATRIC-PATIENTS

Background: The presence of significant elevation of pulmonary vascula r resistance is a major risk factor for death after orthotopic heart t ransplantation. The choice of procedure for the pediatric patient rema ins contentious. Methods: We report three pediatric patients with pulm onary hypertension and raised pulmonary resistance, including two infa nts, in whom heterotopic transplantation was performed with smaller do nor hearts. The hearts were anastomosed to provide left ventricular su pport alone because predominant left ventricular failure was present, the pulmonary resistance was expected to fall gradually after surgery, and we wished to avoid the potential problems of a pulmonary conduit associated with growth and possible reoperation. Results: The clinical results have been satisfactory in all three patients, who were well a nd without symptoms. No pulmonary compromise was observed in the small er thoracic cavity of the two infants. The transpulmonary gradient fel l in all three patients, although this reduction was not immediate. Co nclusions: This technique in carefully selected recipients can allow s afer transplantation in pediatric patients with elevated pulmonary res istance, can increase the donor pool by allowing use of smaller hearts and nonideal donors, and may reduce the mortality on the transplant w aiting list by providing earlier transplantation.