First heart transplantation in a small child in Romania.

Heart transplantation is a life-saving procedure for irreducible heart failure in children as in adults. Worldwide there is a great amount of experience with this procedure, while Romania is only at the beginning. The authors are presenting the experience concerning the first small child heart transplantation in Romania, underlining the pre-operative and posttransplantation experience. The patient, a 3 year-old girl, diagnosed with class IV NYHA functional classification congestive heart failure secondary to an idiopathic dilated cardiomyopathy, has received an isogroup isoRh donor heart on the 14th of January 2011. The operative technique used was an orthotopic bicaval technique. In-hospital postoperative evolution was favourable, the child receiving triple immunosuppressive therapy and prophylaxis therapy against cytomegalovirus, fungi, and pneumocystis carinii bacteria. Myocardial biopsy performed 1 month after transplantation showed no signs of rejection. The child is in good health at 31 months (2 years, 8 months) after the transplantation. Heart transplantation in children is the result of teamwork, while the procedure can be performed with low mortality and morbidity in centers with large experience in heart transplantation and pediatric cardiovascular surgery.

Indication for transplantation in a patient with univentricular heart.

Surgical correction of the univentrivular heart is an achievement of the last 4-5 decades. The Fontan pathway is nowadays an established but continuously improving surgical technique.Nevertheless, attrition of the univentricular heart is a well known process, its timing depending on several factors:technique, time of operation, type of ventricle aso. The study group is represented by 39 patients with univentricular circulation, operated (37 partial-PCPC and 2 total - TCPC cavo-pulmonary anastomosis) in our clinic between 2006 -2012. Out of this group, 2 patients have reached the stage of indication for heart transplantation: 1 has already been transplanted and one is listed for transplantation. The indication was in both a failing ventricle of left-type univentricular heart,in a PCPC status, performed after 14 years of age. Evolution in the transplanted patient is good. In conclusion, the option of heart transplantation should be available and kept in mind for the operated univentricular heart even at pediatric ages, as local peculiarities cause these hearts to fail even earlier than described in the literature.