全心脏原位移植(附4例报告)

目的总结4例全心脏原位移植的经验。方法我院于2005年4月至2006年12月对4例扩张型心肌病患者施行了全心脏原位移植手术,其中男性2例,女性2例,年龄32～57岁。供体均为急性脑死亡者。供心心肌保护3例为UW,1例为HTK液。全心脏移植吻合次序依次左肺静脉、右肺静脉、下腔静脉、上腔静脉、肺动脉及主动脉,其中2例由于受体全心脏扩大,按常规保留的受体上、下腔静脉长度无法与供体腔静脉吻合,为此,截取一段长4cm的供体肺动脉,一端与受体下腔静脉吻合,另一端与供体下腔静脉吻合。吻合时间78～104min,主动脉阻断时间136～197min,体外循环时间202～261min。主动脉开放后,1例电击复跳,3例自动复跳,均为窦性心律,未安置心脏临时起搏器。结果患者术后3～6h神志清楚,14～19h拔除气管插管,6d拔除所有侵入性监测管道,两周后从ICU迁至普通病房,1例术后52d出现急性排异反应,经处理得到控制,均痊愈出院。术后随访心功能均为I级,窦性心律,2例有轻度三尖瓣反流,2例已经恢复工作。结论全心脏原位移植法不仅保存左右心房解剖上完整性,有利于心功能恢复,减少移植后血栓的发生率,而且使房、室间隔传导系统的完整性免遭破坏,降低了心律失常的发生率,这是一种值得推荐的心脏移植方法。

Report of 4 cases of total orthotopic cardiac transplantation

Objective To discuss the experience of 4 cases of total orthotopic cardiac transplantation.Methods From April 2005 to December 2006,4 patients with dilated cardiomyopathy underwent total orthotopic cardiac transplantation.2 patients were males and 2 females.The patients' age were 32-57 respectively.All donor hearts were got from acute brain deaths.Among 4 cases,3 donor hearts were preserved by UW and 1 was preserved by HTK.We generally anastomosed the left pulmonary vein,right pulmonary vein,Infra vena cava,super vena cava,pulmonary artery and aorta by turns.Among them 2 patients' vena cava were not long enough to be anastomosed with donor hearts'.Because of whole hearts expands,a 4 cm donor pulmonary artery was cut to anastomose the donor's postcava and the patients'.The time of anastomosis were 78-104 min respectively.The time of arterial blood flow stop were 136-197 min respectively.And the extracorporeal circulation time were 202-261 min respectively.After operation,1 heart was recovery by electrovert and 3 hearts were self-recovery.Results The patients became consciousness after 3-6 hours after operation respectively and the endotracheal tube were removed after 14-19 hour.All invaded ward pipeline were removed after 6 days,and patients were transfered from ICU to common sickroom after 2 weeks.Among 4 cases,1 accurred actue rejection at the 52ed day after operation,and was controlled a week later.All patients were survived with good lives,only 2 with light tricuspid valve regurgilation,and 2 of the cases have been resumed to work.Conclusion Total orthotopic cardiac transplantation not only saves the anatomic integrity of the atria,be useful to the recovery of heart function,reduces thrombogenesis after the heart transplantation,but also avoids the destruction of atrioventricular bundle.