A Case Report of Heart Transplantation Bridged by Bi-ventricular Assist Device in a Pediatric Patient of Prerenal Type ARF

소아환자에서 양심실 순환보조를 중개로 한 후 발생한 급성신부전 환자에서의 심장 이식수술 치험 1예

  • Ra, Yong-Joon (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Koak, Jae-Gun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Kim, Jin-Hyun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Oh, Se-Jin (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Lee, Jae-Hang (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Kim, Woong-Han (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital)
  • 나용준 (서울대학교병원 흉부외과) ;
  • 곽재건 (서울대학교병원 흉부외과) ;
  • 김진현 (서울대학교병원 흉부외과) ;
  • 오세진 (서울대학교병원 흉부외과) ;
  • 이재항 (서울대학교병원 흉부외과) ;
  • 김웅한 (서울대학교병원 흉부외과)
  • Published : 2006.11.05

Abstract

The patient was an eight-year-old female. She was diagnosed as dilated cardiomyopathy. She was supported with bi-ventricular assist because of heart failure for 15 days. After 7 days, she was suffered from prerenal type ARF and support with continuous veno-veno hemodyalisis(CVVHD). And then heart transplantation was performed, heart donor's blood type was A. Immune suppressants were used after due consideration for renal toxicity. ARF was resolved on post operative $14^{th}$ day. She was discharged on post operative $52^{nd}$ day without any specific post operative complication. She has been followed up without any immune rejection reaction upto 14 months.

환자는 8세 여자 환자로 확장성 심근병증을 진단 받은 환자이다. 환자는 심부전으로 인하여 양심실 순환보조를 15일간 시행하였다. 15일 중 후반기 7일은 급성 신부전증이 발생하여 지속적 정맥-정맥간 혈액투석을 시행하였다. 이후 뇌사상태의 A형 혈액형을 가진 심장 공여자에게서 심장을 이식받아 심장이식술을 시행하였다. 면역 억제제는 급성 신부전증을 고려하여 사용하였다. 신부전 상해는 2주간 지속되었고, 심장 이식술 후 약 14일 후 배뇨가 시작되었다. 환자는 수술 후 12일째에 시행한 우심실 조직검사에서 특별한 거부반응의 증거가 없었으며, 면역요법 후 수술 후 52일째에 특별한 문제 없이 퇴원하였다. 환자는 술 후 약 14개월간 조직검사에서 면역 거부반응 없이 외래 경과관찰 중이다.

Keywords

References

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