Heart valve donation in two small infants

Abstract

The shortage of small donor heart valves forces surgeons to use mechanical heart valves as the second-best option for valve replacement in infants. This shortage of small donor heart valves originates primarily in the unawareness of physicians of the possibility of heart valve donation in infants [2]. In view of the current shortage of small donor heart valves we report here on two cases of heart valve donation in small infants in an attempt to increase physicians’ awareness of the problem. Case 1 was a 6-month-old male infant who developed a septic shock during screening for orthotopic liver transplantation for end-stage liver failure due to biliary atresia. He was admitted to the pediatric intensive care unit, where he eventually died of ongoing sepsis. In light of their son’s possible liver transplantation the parents had studied the matter of donation extensively and requested that his heart valves be harvested for donation. They were aware that bacterial cultures would have to be performed and that the valves would have to be discarded if a micro-organism was cultured. Cultures remained negative, and 8-weeks later the pulmonary valve was successfully implanted in a 5-weekold male infant. Case 2 was a 5-week-old male infant with a history of severe neonatal epilepsy who was admitted to the pediatric intensive care unit because of respiratory failure. Severe brain damage without the possibility of meaningful recovery was diagnosed on the basis of the clinical picture and electroencephalograms (EEG’s). Intensive care was withdrawn, and the infant died. Having become aware of the possibility of tissue donation in infants by the parents of the infant described in case 1, we asked the parents to consider heart valve donation. They agreed under the condition that the heart would be returned in time for the funeral. After consultation with the Bio Implant ServicesFoundation (BIS-Foundation), which is the intermediary in the donation and allocation of human tissues for The Netherlands, Belgium, Germany, Slovenia and Austria, we were able to provide this guarantee. Ten weeks later the aortic valve was successfully implanted in a 10-day-old female infant. Most people who die are able to donate tissue, and in this respect tissue donation differs substantially from organ donation. Organ donation remains primarily restricted to the Intensive Care Unit (ICU), despite the recent development of non-heart-beating organ donation. For this reason, the pool of potential tissue donors is much larger than the pool of potential organ donors. However, despite this large pool, shortage of donor tissues exists [1, 2]. Tissue donation involves the cornea, skin, bone and heart valves. In children, tissue donation is limited to the cornea (in children over 2 years of age) and heart valves. Because of size and maturation issues, the donation of skin, cartilage and bone is only possible in individuals over 16 years of age. In infants the main indications for valve replacement are critical aortic valve stenosis and right outflow tract abnormalities (i.e. pulmonary atresia, truncus arteriosus and severe tetralogy of Fallot). In critical aortic stenosis, the Ross procedure is the operative technique of choice: the patient’s own pulmonary valve serves as an autograft for the stenotic aortic valve, and an appropriately sized pulmonary or aortic valve allograft is used to replace the pulmonary valve [5]. Autografts are preferred because they J. K. Kieboom (*) Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands e-mail: j.k.w.kieboom@bkk.umcg.nl Tel.: +31-50-3614294 Fax: +31-50-3614235