Indications For Heart Transplantation In Children

In neonates (1-30 days), the primary indication for cardiac transplantation is hypoplastic left heart syndrome. These babies have essentially no left ventricle, only a right ventricle. The other surgical option for these babies is an initial "Norwood" procedure followed by a bidirectional Glenn at 6 months of age and a Fontan at 2 years of age. There is currently much debate at different centers as to which approach is better, neonatal orthotopic cardiac transplantation (OCT) with arch reconstruction or staged palliation with an initial Norwood. In a recent review Starnes and associates concluded that given the existing data, these infants should be managed selectively on the basis of donor availability and family wishes.6 In older children the two primary indications are cardiomyopathy and cardiac failure after conventional cardiac repairs. Indications for the 99 children transplanted at Children's Memorial Hospital from 1988 through 2003 are shown in

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