RESUMO
Pediatric patients awaiting heart transplant face high mortality rates due to donor organ shortages, including non-use of marginal donor hearts. We examined national trends in pediatric marginal donor heart use over time. UNOS data were queried for heart donors <18 years from 2005 to 2014. The proportion of donor hearts considered marginal was determined using previously cited marginal characteristics: left ventricular ejection fraction (LVEF) <50%, use of ≥2 inotropes, cerebrovascular death, CDC high-risk status, and eGFR < 30 mL/min/1.73 m2 . Disposition of donor hearts was determined and stratified by marginal donor status. Of 6778 pediatric hearts offered from 2005 to 2014, 2373 (35.0%) were considered marginal. Non-use of marginal donor hearts was significantly higher than that of donor hearts without any marginal characteristics (59.5% vs 20.3%, P < .001). In particular, LVEF < 50% and donor inotropes were associated with high rates of organ non-use among pediatric donors. Yet, non-use of marginal donor organs decreased from 67% to 48% from 2005 to 2014 (P < .001). Although the proportion of pediatric donor hearts used for pediatric patients has increased, more than half of donor hearts are declined for use in pediatric recipients due, in part, to perceived marginal status.
Assuntos
Seleção do Doador/tendências , Transplante de Coração , Doadores de Tecidos/provisão & distribuição , Adolescente , Criança , Pré-Escolar , Seleção do Doador/normas , Seleção do Doador/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Sistema de Registros , Estudos Retrospectivos , Estados UnidosRESUMO
We report the case of a 16-year-old girl diagnosed with myocarditis, although initial echocardiographic imaging was consistent with hypertrophic cardiomyopathy (HCM). The diagnosis of myocarditis was made with the findings of troponin elevation, presence of influenza A, and a more characteristic electrocardiogram. She eventually made a full recovery. Clinicians must be vigilant for such rare presentations of myocarditis masquerading as HCM.
RESUMO
Mitral valve construction using decellularized bovine pericardium is a new procedure. A 10-month-old infant with neonatal Marfan syndrome underwent mitral valve replacement due to severe mitral regurgitation with a cylinder valve constructed from decellularized bovine pericardium. Nineteen months postoperatively the patient is clinically well with trivial mitral regurgitation, mild stenosis, and without need for anticoagulation.