In response to the limited number of available donors, the criteria for accepting hearts have been expanded. In a 46-year-old female (160 cm, 56 kg) with a body surface area (BSA) of 1.58 m2, an orthotopic heart transplantation was performed. She received the heart from a 34-year-old male donor (190 cm, 90 kg, BSA 2.58 m2). During transplantation, the obvious difference between the donor's heart and the recipient's pericardium did not cause a technical problem. However, the postoperative course was characterized by severe circulation problems. Due to a hemodynamically significant right heart impression, a consecutive pericardectomy had to be performed. After excision of the left and the right side of the pericardium, the patient returned to a stable condition. The consecutive course was without cardiopulmonary problems and the patient was discharged from the hospital 20 days later. The last twelve-month follow-up showed good cardiac function and excellent physical condition. We conclude that an oversized donor heart can be used for heart transplantation as long as the pericardium is left open and a left and right pericardectomy is performed.
Key words:
Mismatch - Oversize - Pericardial Tamponade - Pericardectomy
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Received for Publication: March 19, 2001
Georg Trummer, MD
Department of Cardiovascular Surgery
Albert-Ludwigs-University Freiburg, Germany
Hugstetter Straße 55
79106 Freiburg
Telefon: + 49-761-2702818
Fax: + 49-761-2702550
eMail: georg_trummer@yahoo.com
