Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942012000200012
Brazilian Journal of Anesthesiology
Clinical Information

A importância do ecocardiograma transesofágico na captação do coração para transplante cardíaco

The importance of transesophageal echocardiography in heart harvesting for cardiac transplantation

Marcello Fonseca Salgado Filho; Arthur Siciliano; Alexandre Siciliano; Andrey José de Oliveira; Júlia Salgado; Izabela Palitot

http://dx.doi.org/10.1590/S0034-70942012000200012 Braz J Anesthesiol, vol.62, n2, p.265-268, 2012
PDF Português
PDF English
Downloads: 0
Views: 1029

Resumo

JUSTIFICATIVA E OBJETIVOS: A utilização do ecocardiograma transesofágico na captação para o transplante cardíaco pode orientar a avaliação do coração, pois, se for captado um coração marginal, pode-se colocar em risco o sucesso do transplante cardíaco. RELATO DO CASO: Homem, 30 anos, sofreu um acidente automobilístico que lhe causou um TCE grave, evoluindo para morte cerebral. O paciente encontrava-se entubado, ventilando com auxílio de um respirador, 0,6 de fração inspirada de oxigênio, VC 500 mL, FR 14 irpm, PEEP de 3 mmHg, 99% de saturação periférica de O2 e gasometria normal. Estava também hipovolêmico, com débito urinário de 9.300 mL.dia-1, sódio de 157 meq.L-1, hematócrito de 27% e PAI 90x60 mmHg mantida por infusão de noradrenalina a 0,5 mcg.kg.min-1. Foi otimizado clinicamente e avaliado pelo ecocardiograma transesofágico (ETE), que mostrava cavidades cardíacas de tamanho normal, fração de ejeção de 66%, válvulas cardíacas anatômicas e sem alterações funcionais e forâmen oval íntegro. Imediatamente após a confirmação da viabilidade cardíaca e estabilização clínica, o paciente foi encaminhado ao centro cirúrgico e iniciou-se a captação. O período de isquemia teve a duração de duas horas e o coração foi transplantado com sucesso. CONCLUSÕES: Na maioria dos serviços de transplante cardíaco, a avaliação do coração é realizada de forma subjetiva pelo cirurgião, que muitas vezes não tem o suporte do anestesiologista para otimizar clinicamente o doador. No Instituto Nacional de Cardiologia (INC/MS), o anestesiologista faz parte da equipe de captação para poder realizar o ETE intraoperatório, avaliando de forma objetiva o coração captado. Desta forma, proporcionam-se maiores chances de sucesso do transplante cardíaco com um menor custo para o sistema público de saúde brasileiro.

Palavras-chave

CIRURGIA, DOENÇAS, EXAMES DIAGNÓSTICOS, EXAMES DIAGNÓSTICOS

Abstract

BACKGROUND AND OBJECTIVES: The use of transesophageal echocardiography (TEE) during heart harvesting for transplantation can guide the heart assessment, as harvesting a marginal heart can jeopardize the cardiac transplantation. CASE REPORT: Male, 30 years old, suffered a car crash that resulted in a severe traumatic brain injury (TBI) that evolved to brain death. The patient was intubated and ventilated with a fraction of inspired oxygen of 0.6, presetting Vt 500 mL, RR 14 bpm, PEEP of 3 mmHg, 99% O2 saturation, and normal blood gases. He was also hypovolemic, with urine output of 9,300 mL.day-1, sodium level of 157 mEq.L-1, hematocrit of 27%, and BP 90/60 mmHg maintained by infusion of norepinephrine 0.5 mcg.kg.min-1. The patient was clinically optimized and evaluated by TEE, which showed normal size cardiac chambers, ejection fraction 66%, anatomical and functional heart valves with no changes, and foramen ovale integrity. Immediately after the confirmation of cardiac viability and clinical stabilization, the patient was taken to the operating room and the harvest began. The ischemic period lasted two hours and the heart was successfully transplanted. CONCLUSIONS: In most heart transplant services, the cardiac assessment is made subjectively by the surgeon who often does not have the anesthesiologist support to clinically optimize the donor. At the Instituto Nacional de Cardiologia (INC/MS), the anesthesiologist is part of the harvesting team in order to perform intraoperative TEE, evaluating objectively the harvested heart. In doing so, it provides greater chances of heart transplantation success with lower costs for the Brazilian public health system.

Keywords

Echocardiography, Heart Diseases, Transplantation

References

Venkateswaran RV, Bonser RS, Steeds RP. The echocardiographic assessment of donor heart function prior to cardiac transplantation. Eur J Echocardiography. 2005;6:260-263.

Anyanwu AC, Rogers CA, Murday AJ. Intrathoracic organ transplantation in the United Kingdom 1995-99: results from the UK cardiothoracic transplant audit. Heart. 2002;87:449-454.

. .

Gilbert EM, Krueger SK, Murray JL. Echocardiographic evaluation of potential cardiac transplant donors. J Thorac Cardiovasc Surg. 1988;95:1003-1007.

Powner DJ, Hendrich A, Nyhuis A, Strate R. Changes in serum catecholamine levels in patients who are brain dead. J Heart Lung Transplant. 1992;11:1046-1053.

Rona G. Catecholamine cardiotoxicity. J Mol Cell Cardiol. 1985;17:291-306.

Lewandowski TJ, Aaronson KD, Pietroski RE, Pagani FD. Discordance in interpretation of potential donor echos. J Heart Lung Transplant. 1998;17(^s1):100.

English TA, Spratt P, Wallwork J. Selection and procurement of hearts for transplantation. Br Med J. 1984;288:1889-1891.

Wijdichs EFM. The diagnosis of brain desth. N Engl J Med. 2001;344:1215-1221.

Shanewise JS, Cheung AT, Aranson S. ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: recommendations of the American Society of Echocardiography Council for Intraoperative echocardiography and he Society of Cardiovascular Anesthesiologist Task Force for certification in perioperative transesophageal Ecocardiography. AnesthAnalg. 1999;89:870-884.

Urbanowicz JH, Shaaban MJ, Cohen NH. Comparison of transesophageal echocardiographic and scintigraphic estimates of left ventricular end-diastolic volume index and ejection fraction in patients following coronary artery bypass grafting. Anesth. 1990;72:607-612.

Szabo G. Physiologic changes after brain death. J Heart Lung Transplant. 2004;23:223-226.

Livi U, Bortolutti U, Luciani Gb. Donor shortage in heart transplantation: Is extension of donor ages limitsjustified?. J Thorac Cardiovasc Surgery. 1994;107:1346-55.

Kron IL, Tribble CG, Kern JA. Successful transplantation of marginally acceptable thoracic organs. Ann Surg. 1993;217:518-524.

Hosenpud JD, Bennet LE, Keck BM. The registry of the international society for heart and lung transplantation: the official report - 2001. J Heart Lung Transplant. 2001;20:805-15.

Novitzky D, Wicomb WN, Cooper DKC. Electrocardiographic, haemodynamic, and endocrine changes occurring during experimental brain death in the Chacma baboon. Heart Transplant. 1984;4:63-69.

Seiler C, Laske A, Galino A. Echografic evalution of left ventricular wall motion before and after transplantation. J Heart Lung Transplant. 1992;11:867-874.

. .

Berry R. Brainstem death and the management of the organ donor. Anaesth Intensive Care. 2006;7:212-214.

5dd54be50e88250b71c8fca7 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections