First heart transplantation in a small child in Romania.

Heart transplantation is a life-saving procedure for irreducible heart failure in children as in adults. Worldwide there is a great amount of experience with this procedure, while Romania is only at the beginning. The authors are presenting the experience concerning the first small child heart transplantation in Romania, underlining the pre-operative and posttransplantation experience. The patient, a 3 year-old girl, diagnosed with class IV NYHA functional classification congestive heart failure secondary to an idiopathic dilated cardiomyopathy, has received an isogroup isoRh donor heart on the 14th of January 2011. The operative technique used was an orthotopic bicaval technique. In-hospital postoperative evolution was favourable, the child receiving triple immunosuppressive therapy and prophylaxis therapy against cytomegalovirus, fungi, and pneumocystis carinii bacteria. Myocardial biopsy performed 1 month after transplantation showed no signs of rejection. The child is in good health at 31 months (2 years, 8 months) after the transplantation. Heart transplantation in children is the result of teamwork, while the procedure can be performed with low mortality and morbidity in centers with large experience in heart transplantation and pediatric cardiovascular surgery.