Cardiac Transplant

Covers indications, contraindications, complications, transplant types, echo findings, strain findings, and TDI findings.

cardiogenic shock

hear cannot pump enough blood to the brain and other organs

inotropic therapy

infusing medicine to change calcium balance in the heart which will improve muscle contraction

NYHA Class III Heart Failure

Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, shortness of breath or chest pain.

NYHA Class IV Heart Failure

Symptoms of heart failure at rest. Any physical activity causes further discomfort.

Peak VO₂ max per minute indicating cardiac transplant

< 10 mL/Kg

LV arrhythmia parameters for cardiac transplant

recurring despite defibrillator, ablation, or therapy

indications for cardiac transplant

refractory cardiogenic shock needing IABP or LVAD
cardiogenic shock needing IV inotropic therapy
peak VO₂ max <10 mL/Kg per minute
NYHA class III or IV HF despite treatment
recurrent life-threatening LV arrhythmias
end-stage CHD without PHTN
refractory angina w/o other treatment options

contraindications for cardiac transplant

systemic illness with limited life expectancy
irreversible PHTN
clinically severe symptomatic cerebrovascular disease
active substance abuse
inadequate social support or cognitive-behavioral disability
multi-symptom disease with severe extracardiac dysfunction

complications of cardiac transplant

acute cellular rejection (ACR)
cardiac allograft vasculopathy
side effects of immunosuppression therapy

acute cellular rejection (ACR)

endocardial myocardial biopsy to monitor, performed under fluoroscopy or echocardiography

orthotopic transplant (biatrial or bicaval)

recipient’s heart is removed and donor heart is placed in correct anatomic position

heterotropic transplant (piggyback)

donor heart is placed in the right chest next to the recipient organ and anastomosed so that blood supply can flow to both hearts

1 month post operation LV changes

LV mass increases and wall thickness increases, resolved within 3 months of transplant

LV findings post transplant

quickly normalizing LVEF, paradoxical septal motion, pericardial effusion

decreased LVEF in 1st year

can predict rejection or CAV

biatrial heart transplant echo finding

biatrial enlargement, may see suture lines

bicaval heart transplant echo finding

initially smaller RA, large LA

Rt heart echo findings post transplant

RV systolic dysfunction, RV/RA enlargement common, assess TV

Strain findings post heart transplant

lower LV GLS
lower RV free wall strain

reduced LV torsion > 25% from baseline

may predict ACR

Tissue Doppler post heart transplant

early post-op: LV e’ and s’ start low and gradually recover

systolic wall motion velocity of < 10 cm/s

increased risk of CAV

isovolumetric relaxation time < 10 ms peak velocity

can predict ACR

endomyocardial biopsy with echo guidance post transplant

identify bioptome entering RA and RV
clear view of RV and IVS

bioptome

pinchers used to extract 1-2 mm tissue samples from myocardium

complications of endomyocardial biopsy

RV perforation, pericardial effusion, damage to TV and apparatus, right branch bundle block