The treatment of neonates with unrepairable heart valve dysfunction remains an unsolved problem because there are no growing heart valve replacements. Heart valve transplantation is a potential approach to deliver growing heart valve replacements. Therefore, we retrospectively analysed the semilunar valve function of orthotopic heart transplants during rejection episodes.

We included children who underwent orthotopic heart transplantation at our institution and experienced at least one episode of rejection between 1/1/2010 and 1/1/2020. Semilunar valve function was analysed using echocardiography at baseline, during rejection and approximately 3 months after rejection.

Included were a total of 31 episodes of rejection. All patients had either no (27) or trivial (4) aortic insufficiency prior to rejection. One patient developed mild aortic insufficiency during a rejection episode (P = 0.73), and all patients had either no (21) or trivial (7) aortic insufficiency at follow-up (P = 0.40). All patients had mild or less pulmonary insufficiency prior to rejection, which did not significantly change during (P = 0.40) or following rejection (P = 0.35). Similarly, compared to maximum pressure gradients across the valves at baseline, which were trivial, there was no appreciable change in the gradient across the aortic valve during (P = 0.50) or following rejection (P = 0.42), nor was there any meaningful change in the gradient across the pulmonary valve during (P = 0.55) or following rejection (P = 0.91).

This study demonstrated that there was no echocardiographic evidence of change in semilunar valve function during episodes of rejection in patient with heart transplants. These findings indicate that heart valve transplants require lower levels of immune suppression than orthotopic heart transplants and provide partial foundational evidence to justify future research that will determine whether heart valve transplantation may deliver growing heart valve replacements for children.

患有不可修复的心脏瓣膜功能障碍的新生儿的治疗仍然是一个未解决的问题，因为没有生长的心脏瓣膜替代物。心脏瓣膜移植是提供不断生长的心脏瓣膜替代物的潜在方法。因此，我们回顾性分析了原位心脏移植排斥反应期间的半月瓣功能。

我们纳入了在我们机构接受原位心脏移植并在 2010 年 1 月 1 日至 2020 年 1 月 1 日期间至少经历过一次排斥反应的儿童。在基线、排斥期间和排斥后约 3 个月时使用超声心动图分析半月瓣功能。

其中总共有 31 次排斥反应。所有患者在排斥前都没有 (27) 或轻微 (4) 主动脉瓣关闭不全。一名患者在排斥反应期间出现轻度主动脉瓣关闭不全（P = 0.73），所有患者在随访时要么没有（21）例出现主动脉瓣关闭不全，要么有轻微（7）主动脉瓣关闭不全（P = 0.40）。所有患者在排斥前均有轻度或较轻的肺功能不全，在排斥期间（ P = 0.40）或排斥后（P = 0.35）没有显着变化。同样，与基线时瓣膜上的最大压力梯度相比（这是微不足道的），在排斥期间（ P = 0.50）或排斥后（P = 0.42 ），主动脉瓣上的梯度没有明显的变化，也没有任何有意义的变化在排斥期间（ P = 0.55）或排斥后（P = 0.91）穿过肺动脉瓣的梯度。

这项研究表明，在心脏移植患者发生排斥反应期间，没有超声心动图证据表明半月瓣功能发生变化。这些发现表明，心脏瓣膜移植需要比原位心脏移植更低水平的免疫抑制，并提供部分基础证据来证明未来研究的合理性，以确定心脏瓣膜移植是否可以为儿童提供生长中的心脏瓣膜替代物。