儿童心外膜和微血管移植血管病

作     者：Hiemann N. E. Wellnhofer E. Abdul-Khaliq H. 贺莉 

作者机构：Deutsche s Herzzentrum Berlin Dept. of Cardiothorac. / Vasc. Surg. Augustenburger Plat z 1 13353 Berlin Germany 

出 版 物：《世界核心医学期刊文摘（儿科学分册）》 (Dkgest of the World Latest Medical Information)

年 卷 期：2005年第1卷第5期

页      面：15-16页

学科分类：1002[医学-临床医学] 100202[医学-儿科学] 10[医学] 

主　　题：移植血管 心脏移植 心肺移植 性细胞 内皮细胞 冠状动脉造影 血管反应 管壁增厚 血管直径 血管闭塞 

摘      要：Aim: Graft vessel disease (GVD) is one of the main limiting factors to long-t erm survival after adult heart transplantation (HTx). The incidence of epicardia l and microvascular GVD in paediatric patients was studied. Methods: A total of 137 coronary angiographies from 130 paediatric HTx and heart and lung transplant (HLTx) patients (70 male, 60 female, aged 0-18 y) were evaluated according to the Stanford classification and its supplements (minor vessel alterations). In H &E stainings from right ventricular endomyocardial biopsies (EMB = 397), light microscopic diagnosis of acute cellular rejection (ISHLT classification) and vas cular reaction (morphology of endothelial cells and vessel walls) was performed. Results: Moderate rejection was present in 32.8%and severe rejection in 13.3 %of EMB. Microvascular EC swelling was found in 33.5%and vessel wall thickeni ng in 53.8%of EMB. The results of the coronary angiographic investigations wer e: Stanford lesions = 61.2%, peripheral obliterations = 52.5%, diameter fluc tuations = 86.3%, pathologic tapering = 64.0%, calcifications = 10.8%. Lon g-term survivors (≥5 y) showed macrovascular alterations in 78%of cases and m icrovascular alterations in 67%of cases. Conclusion: The development of micro- and macrovascular GVD is one of the predominant complications in long-term surv ivors after paediatric HTx and HLTx.