Heart transplantation: echocardiographic assessment of morphology and function after more than 10 years of follow-up.
BACKGROUND
Over recent years, heart transplantation (HTX) developed into a successful option for long-term treatment of end-stage heart failure. Ten-year survival ranges between 40% and 50%. Little is known, however, about function and morphology of transplanted hearts during follow-up of more than 10 years.


METHODS
In a consecutive cohort of 65 patients (55 male, 54.6 +/- 12.1 years at the time of transplantation), graft function was assessed by color Doppler echocardiography 12.5 +/- 1.4 years after heart transplantation (10 to 15 years).


RESULTS
Left atrial and ventricular dimensions were found in a normal range (LA 37.7 +/- 8.9 mm, LV enddiastolic 45.6 +/- 6.4 mm, 30 to 71 mm). Ejection fraction (EF) of 71 +/- 11.7% and a fractional shortening of 35.3 +/- 10.3% presented with normal values. Left ventricular mass (male 263.8 +/- 111.4 g, female 373.0 +/- 181.1 g) was slightly increased resulting in mild hypertrophy in women. Focused on right ventricular morphology, enlargement of both the right atrium and the right ventricle (RA 40.7 +/- 11.8 mm, RV 37.4 +/- 8.3 mm) was observed in the majority of the patients. Tricuspid valve insufficiency (> grade II) was present in 46 of 65 patients; 5 patients had previously undergone tricuspid valve replacement. Atrial filling waves were detectable in only 47 of 65 patients, thus, 28% of patients showed signs of LA-dysfunction.


CONCLUSIONS
More than 10 years post-HTX, cardiac grafts were characterized by normal left ventricular dimensions and ejection fraction. LA-dysfunction and RV-enlargement associated with tricuspid insufficiency were frequent findings, however, not associated with clinical signs of congestive heart failure in the majority of patients.
Wilhelmi
Michaela
M
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany. wilhelmi@thg.mh-hannover.de
Pethig
Klaus
K
Wilhelmi
Mathias
M
Nguyen
Hien
H
Strüber
Martin
M
Haverich
Axel
A
D000328:Adult; D018618:Echocardiography, Doppler, Color; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000033:anatomy & histology / Q000502:physiology; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013318:Stroke Volume; D013997:Time Factors