Skip to Main Content

240: HEART TRANSPLANT: PEDIATRIC

Kay Tasso, PhD, PT, PCS

CONDITION/DISORDER SYNONYM

  • Cardiac transplant

ICD-9-CM CODE

  • V42.1 Heart replaced by transplant

ICD-10-CM CODE

  • Z94.1 Heart transplant status

PREFERRED PRACTICE PATTERN

  • 6C: Impaired Ventilation, Respiration/Gas Exchange, and Aerobic Capacity/Endurance Associated with Airway Clearance Dysfunction

PATIENT PRESENTATION

An 11-month-old infant is referred from an early intervention program for natural environment (home) physical therapy following a heart transplant 6 months ago for hypoplastic left heart syndrome. He has a gastrostomy tube (G-tube) for all feedings due to unwillingness to take food by mouth. The child requires 1 L of oxygen via a nasal cannula and uses an oxygen saturation monitor at night. He takes the following medications: cyclosporine, captopril, zantac, prednisone, heparin, bactrim, and valcyte valganciclovir. Developmentally, he can prop sit but is not yet rolling, creeping on hands and knees, or transferring in or out of sitting or quadruped.

KEY FEATURES

Description

  • Diseased or defective heart is partially (heterotopic transplant) or completely (orthotopic transplant) removed due to heart failure

  • A healthy donor heart from a deceased person is implanted

Essentials of Diagnosis

  • Severity of heart failure classification1

    • Stage A: At risk for heart failure

    • Stage B: Abnormal structure or function but no heart failure

    • Stage C: Abnormal structure or function and history of or current heart failure

    • Stage D: Abnormal structure or function resulting in ventilator or cardiac support

General Considerations

  • The heart is considered denervated (due to severing of thoracic and vagus nerves2) following transplantation

    • Pulse rate can no longer be utilized as the primary method of assessing intensity of exercise

    • Circulating catecholamines regulate the heart’s response to exercise

    • As a result, a warm-up period prior to exercise and a cool down period following exercise are crucial to any active exercise program

Demographics

  • 5000 heart transplants per year including adults and children

FIGURE 240-1

Actuarial survival for adult and pediatric heart transplant patients performed between January 1982 and June 2004. The half-life is the time at which 50% of those transplanted remain alive, and the conditional half-life is the time at which 50% recipients surviving the first year after transplantation. (Reprinted from Taylor DO, Edwards LB, Aurora P, et al. Registry of the International Society for Heart and Lung Transplantation: twenty-fifth official adult heart transplant report—2008. J Heart Lung Transplant. 2008;27(9):943–956. Copyright 2010, with permission from Elsevier.)

image
View Full Size||Download Slide (.ppt)
FIGURE 240-2

ECG in a heart transplant patient. ECG demonstrating donor and recipient P waves (arrowhead, donor P wave; arrow, recipient P wave). (From Tintinalli JE, Stephan Stapczynski J, John ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MH Privacy Center Close