Miguel Barbero-Marcial; Estela Azeka; Paulo Roberto Camargo; Marcelo B Jatene; Arlindo Riso; José Otávio C Auler Júnior; José Soares; Cristina Monteiro; Davi Uip; Luis Camargo; Sílvia Santos; Verônica Coelho; Edmar Atik; Munir Ebaid; Adib D Jatene
DOI: 10.1590/S0102-76381996000200003
RESUMO
OBJETIVO: Relatar as características do transplante cardíaco neonatal e pediátrico em crianças portadoras de cardiopatias complexas e cardiomiopatias retratarias à terapêutica convencional. O presente trabalho mostra a experiência de três anos e meio deste procedimento no Instituto do Coração HC-FMUSP. MÉTODOS: A metodologia empregada consistiu-se na técnica cirúrgica nos casos de cardiopatias congênitas, critérios de indicação para o transplante e viabilidade do doador, manuseio pós-operatório, imunosupressão, prevenção e tratamento de potenciais complicações. RESULTADOS: De novembro de 1992 a junho de 1996, 14 crianças foram transplantadas com idade de 12 dias a seis anos (média de 2,2 anos); 57% do sexo masculino; peso de 3,5 kg a 17,8 kg (média de 10,3 kg). Os doadores tinham de 21 dias a dez anos de idade(média de 4,4 anos); 80% do sexo masculino; peso variando de 3,8 a 20 kg (média de 14,3 kg). A sobrevida foi de 85,7% (2 óbitos em 14 pacientes). O tempo de seguimento foi de um mês a três anos e seis meses (média de 16 meses). As principais complicações foram hipertensão arterial sistêmica, rejeição aguda e infecção. O número de rejeições por paciente foi de 3,5 episódios e de infecção foi de 3,3 episódios. CONCLUSÃO: O transplante cardíaco consistiu-se em promissora opção terapêutica com sobrevida de 85,7% a médio prazo.ABSTRACT
OBJECTIVE: Relate the characteristics of the heart transplantation in children with complex congenital heart diseases and severe cardiomyopathies. The present article was written to show the three year experience of this procedure at the Instituto do Coração HC-FMUSP. METHODS: The methodology used was based on surgical procedure in congenital heart disease, heart transplant indication criteria, inclusion criteria for donors, postoperative management, immunosupression and prophylaxis as well as treatment for potential complications. RESULTS: From November 1992 to June 1996, fourteen children, aged 12 days old to six years of age (mean: 2.2 years), underwent transplantation. Fifty-seven percent of recipients were male; weight ranged from 3.5 to 17.8 kg (mean: 10.3 kg). The mean age of donors was 4.4 years (a range of three weeks to ten years), 80% male, weight ranging from 3.8 to 20 kg (median 14.3 kg). The survival rate was 85.7% (two deaths in 14 patients). The follow-up was between one month to three years (average 16 months). The most important complications were systemic hypertension, acute rejection and infection. The number of rejections and infections per patient were 3.5 and 3.3 episodes respectively. CONCLUSIONS: In this experience heart transplantation has been giving a chance for children with complex congenital heart diseases and cardiomyopathies, with a survival rate of 85.7%. Texto completo disponível apenas em PDF.REFERÊNCIAS
1. Barnard C N - A Human cardiac transplant: an interim report of a successful operation performed at Gröote Schuur Hospital, Cape Town. S Afr Med J 1967; 41: 1271-4. [MedLine]
2. Kantrowitz A, Haller J D, Joos H et al. - Transplantation of the heart in an infant and an adult. Am J Cardiol 1968; 22: 782-90 [MedLine]
3. Kahan B D - Immunosuppressive therapy with cyclosporine for cardiac transplantation. Circulation 1987; 75: 40-56. [MedLine]
4. BAILEY L L, NEHLSEN-CANNARELLA S L, CONCEPCION W et al. - Baboon-to-human cardiac xenotransplantation in a neonate. JAMA 1985; 254: 3321-9. [MedLine]
5. Bailey L L, Nehlsen-Cannarella S L, Doroshow R W et al. - Cardiac allotransplantation in newborns as therapy for hypoplastic left heart syndrome. NEJM 1986; 315: 949-51.
6. Razzouk A J & Bailey L L - Infant heart transplantation. In: Emmanouilides G C, Riemenschneider T A, Allen H D, Gutgesell H P, eds. Moss and Adams Heart disease in infants, children and adolescents including the fetus and young adult. 5th ed. Baltimore: Williams & Wilkins, 1995; 510-9.
7. Barbero-Marcial M, Azeka E, Camargo P R et al. - Transplante cardíaco neonatal e infantil. Arq Bras Cardiol 1996; (No prelo). [MedLine]
8. International Heart and Lung Transplantation Society-Pediatric heart transplantation. Heart Lung Transplant 1993; 12: S153-S378.
9. Loma Linda Pediatric Heart Transplantation Protocol. Loma Linda: Loma Linda University, 1993; 1-119.
10. Castañeda A, Jonas R A, Mayer J E et al. - Cardiac surgery of the neonate and infant. Philadelphia: WB Saunders Company, 1994; 467-78.
11. Fricker F J & Armitage J M - Heart and heart-lung transplantation in children and adolescents. In: Emmanouilides G C, Riemenschneider T A, Allen H D, Gutgesell H P, eds. Moss and Adams heart disease in infants, children and adolescents including the fetus and young adult. 5th ed. Baltimore: Willians & Wilkins, 1995; 495-509.
12. Kirklin J W & Barrat-Boyes B - Cardiac surgery. 2nd ed. New York: Churchill Livingstone Inc. 1993; 1655-81.
13. Meneguetti J C, Camargo E E, Soares Jr. J et al. Gallium-67 imaging in human heart transplantation: correlation with endomyocardial biopsy. J Heart Transplant 1987; 6: 171-6. [MedLine]
Article receive on sábado, 1 de junho de 1996