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Pediatric heart transplantation is commonly performed as a last resort treatment for severe heart dysfunction. We sought to analyze our 20 years' experience with pediatric heart transplant: long-term outcome and fate at transition to adulthood. Retrospective analysis of all children (< 18 years) who underwent heart transplantation between 01-1999 and 12-2018. Demographic data of donors and recipients, etiology, time on waiting list, hemodynamic data, post-transplantation complications, long-term survival of patient and transplant were collected. Forty-nine transplants were performed in 48 children at median age and weight of 8,3 years [2,9–13,5] and 20,5 kg [13,2–39,5]. 86% had cardiomyopathy (dilated in 57% of those), 8% congenital heart disease and 6% myocarditis. Median time on waiting list was 46 days [19–132] with a trend to increase with time. Global survival reached 88% at 1 year and 80% at 5 years post-transplantation. No death nor organ failure occurred for patients transplanted after January 2011. 9 patients (18%) died, 6(67%) for transplant failure, 2(22%) for septic shock, 1 for post-operative cerebral hypoxia. Graft rejections occurred 32 times in 17 patients (35%). 8 patients of them (47%) were symptomatic, a median of 16 months after transplant [6–30]. 1 patient underwent a second combined heart-kidney transplant, 1 had lymphoma. Median age of transition to adult care was 17,9 years [16,5–18,4] after a mean pediatric care of 6,9 years (0,4 to 19,2). Global median follow-up was 3,8 years [1,5–7,9]. At latest follow-up, 36 children (74%) had normal schooling, 7(14%) had some school adaptations, 1 was in a special institution and 1 did not attend school. Our retrospective analysis shows good survival, when compared to current reported data (ISHLT) with normal schooling in 75% of the children, compared to 94% in the normal French population. Quality of life and exercise capacity are currently being studied in our cohort. [ABSTRACT FROM AUTHOR]

Aims: To assess whether abnormal dobutamine stress echocardiography (DSE) can be a consequence of dobutamine-induced coronary spasm in patients with angiographically documented vasospastic coronary arteries. Methods: Between January 2004 and April 2008, we prospectively evaluated all patients with known or suspected coronary artery disease (CAD) referred to the echocardiography laboratory for dobutamine stress tests (6061 examinations). Those with abnormal DSE underwent coronary angiogram with a systematic methylergometrine intracoronary injection in the case of absence of significant coronary stenosis or spontaneous occlusive coronary spasm. Patients who had spontaneous occlusive coronary spasm or positive methylergometrine test, but no significant stenoses, were ultimately included in this study. Results: About 581 patients had abnormal DSE, among them only 20 (3.4%) fulfilled the inclusion criteria. There were 15 males and 5 females, and mean age was 64.35 years (range 52-85); 8 patients had a known history of CAD and all of them had at least two established cardiovascular risk factors. The culprit vessel was the left anterior descending artery in 10 cases (50%), right coronary artery in 8 cases (40%), and left circumflex in 2 cases (10%). There was a systematic correspondence between the culprit arteries and dobutamine-induced wall motion abnormality territories. No complications occurred during examination or during the provocation test. All the patients were discharged with a calcium channel blocker and were doing well after 13 months of mean follow-up. Conclusion: Coronary artery spasm can be induced at DSE, but is a rare finding; it could, though, be clinically relevant as it may partly explain some erroneously labelled ‘false-positive’ examinations. Methylergometrine provocation test is a safe and advisable approach in such situations. [Copyright &y& Elsevier]