• Clinical and Experimental Pediatrics
• /
• v.64 no.2
• /
• pp.49-59
• /
• 2021

Since the initial International Society of Heart Lung Transplantation registry was published in 1982, the number of pediatric heart transplantations has increased markedly, reaching a steady state of 500-550 transplantation annually and occupying up to 10% of total heart transplantations. Heart transplantation is considered an established therapeutic option for patients with end-stage heart disease. The long-term outcomes of pediatric heart transplantations were comparable to those of adults. Issues affecting long-term outcomes include acute cellular rejection, antibody-mediated rejection, cardiac allograft vasculopathy, infection, prolonged renal dysfunction, and malignancies such as posttransplant lymphoproliferative disorder. This article focuses on medical issues before pediatric heart transplantation, according to the Korean Network of Organ Sharing registry and as well as major problems such as graft rejection and cardiac allograft vasculopathy. To reduce graft failure rate and improve long-term outcomes, meticulous monitoring for rejection and medication compliance are also important, especially in adolescents.

• Journal of Chest Surgery
• /
• v.53 no.2
• /
• pp.79-81
• /
• 2020

Treatment options for children with end-stage heart failure are limited. We report the first case of a successful pediatric heart transplantation bridged with a durable left ventricular assist device in Korea. A 10-month-old female infant with dilated cardiomyopathy and left ventricular non-compaction was listed for heart transplantation. During the waiting period, the patient's status deteriorated. Therefore, we decided to provide support with a durable left ventricular assist device as a bridge to transplantation. The patient was successfully bridged to heart transplantation with effective support and without any major adverse events.

• Journal of Chest Surgery
• /
• v.46 no.6
• /
• pp.391-401
• /
• 2013

Mechanical circulatory support (MCS) in the pediatric heart failure population has a limited history especially for infants, and neonates. It has been increasingly recognized that there is a rapidly expanding population of children diagnosed and living with heart failure. This expanding population has resulted in increasing numbers of children with medically resistant end-stage heart failure. The traditional therapy for these children has been heart transplantation. However, children with heart failure unlike adults do not have symptoms until they present with end-stage heart failure and therefore, cannot safely wait for transplantation. Many of these children were bridged to heart transplantation utilizing extracorporeal membranous oxygenation as a bridge to transplant which has yielded poor results. As such, industry, clinicians, and the government have refocused interest in developing increasing numbers of MCS options for children living with heart failure as a bridge to transplantation and as a chronic therapy. In this review, we discuss MCS options for short and long-term support that are currently available for infants and children with end-stage heart failure.

• Journal of Chest Surgery
• /
• v.48 no.4
• /
• pp.277-280
• /
• 2015

We report the case of a 37-year-old man who suffered from biventricular failure due to left isomerism, inferior vena cava interruption with azygos vein continuation, bilateral superior vena cava, double outlet of right ventricle, complete atrioventricular septal defect, pulmonary stenosis, and isolated dextrocardia. Heart transplantation in patients with systemic venous anomalies often requires the correction and reconstruction of the upper & lower venous drainage. We present a case of heart transplantation in a patient with left isomerism, highlighting technical modifications to the procedure, including the unifocalization of the caval veins and reconstruction with patch augmentation.

• Archives of Reconstructive Microsurgery
• /
• v.23 no.2
• /
• pp.89-92
• /
• 2014

An 8-year-old girl diagnosed with dilated cardiomyopathy and Russell-Silver syndrome was admitted to our pediatric intensive care unit due to low cardiac output and multiple-organ dysfunction. The patient was placed on the heart transplant waiting list and extracorporeal membrane oxygenation was performed as a bridge to transplantation. After 17 days, heart transplantation was performed. The donor was a 46-year-old female (weight, 50 kg; height, 150 cm). The donor:recipient weight ratio was 3.37:1. Because the dimension and volume of the recipient's thoracic cage were insufficient, the sternum could not be closed. Nine days after transplantation, the patient underwent delayed sternal closure. To obtain adequate space, we left the sternum 4.5 cm apart from each margin using four transverse titanium plates. A transverse rectus abdominis musculocutaneous flap was chosen to cover the wound. Due to the shortage of donors, a size-mismatched pediatric heart transplantation is sometimes unavoidable. Closure of the opened sternum of a transplant recipient can be challenging. Sternal reconstruction after an extremely oversized heart transplantation with transverse titanium plate fixation and a musculocutaneous flap can effectively achieve sternal closure and stability.

• Journal of Chest Surgery
• /
• v.39 no.3 s.260
• /
• pp.226-229
• /
• 2006

Recently, heart transplantation has been accepted as a standard treatment for infant and children with end-stage cardiomyopathy or complex congenital heart disease. Due to the shortage of donors, size-mismatched cardiac transplantation is common. After size-mismatched transplantation, there could be side-effects such as hypertension and hypertensive encephalopathy because of the big-heart. Donor heart is also known to do remodel as time goes by. This is a case report of a size-mismatched heart transplantation between 9-year-old boy and a 39-year-old female whose body weight is almost twice of him. In this case, classical postoperative hypertension and hypertensive encephalopathy developed but was successfully managed. The donor heart has remodeled to normal dimension during 3 years follow-up period.

• Journal of Chest Surgery
• /
• v.50 no.5
• /
• pp.317-325
• /
• 2017

Background: Extracorporeal membrane oxygenation (ECMO) has become an important treatment modality in pediatric patients with cardiopulmonary failure, but few studies have been conducted in Korea. Methods: We conducted a retrospective review of pediatric patients younger than 18 years who were placed on ECMO between January 2004 and December 2014 at Samsung Medical Center. Results: We identified 116 children on ECMO support. The overall rate of successful weaning was 51.7%, and the survival to discharge rate was 37.1%. There were 39, 61, and 16 patients on ECMO for respiratory, cardiac, and extracorporeal cardiopulmonary resuscitation, respectively. The weaning rate in each group was 48.7%, 55.7%, and 43.8%, respectively. The survival rate was 43.6%, 36.1%, and 25.0%, respectively. Sixteen patients on ECMO had functional single ventricle physiology; in this group, the weaning rate was 43.8% and the survival rate was 31.3%. Ten patients were on ECMO as a bridge to transplantation (8 for heart and 2 for lung). In patients with heart transplantation, the rate of survival to transplantation was 50.0%, and the overall rate of survival to discharge was 37.5%. Conclusion: An increasing trend in pediatric ECMO utilization was observed. The outcomes were favorable considering the early experiences that were included in this study and the limited supply of specialized equipment for pediatric patients.

• Clinical and Experimental Pediatrics
• /
• v.64 no.2
• /
• pp.76-77
• /
• 2021

• Journal of Chest Surgery
• /
• v.42 no.5
• /
• pp.630-634
• /
• 2009

According to the 2007 International Society for Heart and Lung Transplantation (ISHLT) report, a congenital diagnosis, infantile transplantation and being on extracorporeal membrane oxygenation (ECMO) at the time of transplant are risk factors for mortality for the patients who undergo a heart transplant, and a large body weight ratio also increases the risk of mortality. The patient of this case underwent a Ross operation and mitral valve repair due to left ventricle outflow track obstruction and mitral regurgitation. But the baby was treated with ECMO due to heart failure after the operation. When he was 3-months-old and had been. on 30 days of ECMO, he underwent a heart transplant with a heart that had a high donor-recipient weight ratio (4.42). We present this case from a technical standpoint and we include a review of the relevant literature.

• Pediatric Infection and Vaccine
• /
• v.29 no.2
• /
• pp.105-109
• /
• 2022

The treatment of invasive infections caused by multidrug-resistant vancomycin-resistant enterococci (VRE) is challenging, particularly in pediatric patients with underlying medical conditions. Newer antibiotics used to treat VRE infections in pediatric patients are insufficiently studied. This report presents the case of a 6-month-old infant who underwent heart-lung transplantation and was successfully treated with a combination of daptomycin and tigecycline for recurrent VRE bacteremia shortly after the discontinuation of linezolid.