心脏移植手术治疗终末期缺血性心肌病3例报告

目的 高患者术后出现一过性右心功能不全表现和心率缓慢,经药物治疗好转.其余2例患者术后恢复顺利.随访7～18个月,无一例免疫排斥反应和免疫抑制药物不良反应发生,无明确感染发生.术后6个月复查超声心动图,左心室射血分数分别为55%、63%和65%.结论 对于终末期缺血性心肌病实施心脏移植手术近期效果较好,肺血管阻力是重要的危险因素.远期效果有待观察.

Heart transplantation in end-stage ischemic myocardiopathy: three-case report

Objective To report the clinical application of heart transplant procedure in end-stage ischemic myocardiopathy. Methods 3 male patients with end-stage ischemic myocardiopathy, aged 48, 55 and 51, respectively were reoprted. Heart failure was the major clinical features and myocardial evalvation indicated that routine revascularization was not applicable. The standard orthotopic heart transplantation procedures were performed in all cases. The hot ischemic time ranged from 5 to 10 minutes and the cold ischemic time ranged from 140 to 160 minutes. The immunosuppressive therapy included cyclosporine A, Mycophenolate mofetil(MMF) and prednisone. Results One patient developed temporary right heart dysfunction because of preoperative pulmonary hypertension and reacted well to medical treatment. The other two patients recovered well after surgery. Patients were followed-up for 7 to 18 months and, no infection or rejection happened. The left ventricular ejection fraction in echocardiography 6 months after the surgery was 55%, 63% and 65% respectively. Conclusions Heart transplantation for end-stage ischemic myocardiopathy shows good early outcomes. The high pulmonary arteriolar resistance is an important risk factor. The long term outcome should be monitored further.