title: Reduction in initial ventricular systolic and diastolic velocities after heart transplantation in children: improvement over time identified by tissue Doppler imaging.
abstract: BACKGROUND
  Tissue Doppler imaging (TDI) is a non-invasive method for measuring ventricular function that can provide insight into the changes in hemodynamics that occur after pediatric heart transplantation. The purpose of this study was to quantify longitudinal changes in myocardial velocities within the first 6 months after transplantation in children.
  
  
  METHODS
  Thirteen patients were serially studied (median age at transplant 5.9 years) and compared with controls. Tissue Doppler systolic (S), early (E) and late (A) diastolic velocities were recorded at the tricuspid annulus, mitral annulus and interventricular septum.
  
  
  RESULTS
  TDI studies were serially performed during 6 months post-transplantation: <10 days (n = 48); 11 to 30 days (n = 26); 31 to 60 days (n = 13); 61 to 120 days (n = 12); and 121 to 180 days (n = 16). Mean systolic tissue velocities at the tricuspid annulus were 3.8 cm/s (95% confidence interval [CI]: 3.1 to 4.6) at baseline (<10 days) and 6.3 cm/s (95% CI: 4.1 to 8.6) at 6 months post-transplantation (mean increase from baseline: 2.5 cm/s; 95% CI: 0.1 to 4.9). Systolic tissue velocities at the mitral annulus also increased over time (mean change from baseline: 0.9 cm/s; p = 0.02). Early diastolic (E) velocities at the tricuspid annulus and mitral annulus significantly improved over time (p < 0.0001 and p = 0.002, respectively). Systolic and diastolic velocities measured at >121 days after transplantation, however, remained significantly lower than those of normal controls.
  
  
  CONCLUSIONS
  TDI demonstrated systolic and diastolic velocities improved during the initial 180 days after heart transplantation. Systolic and diastolic velocities were reduced in children after heart transplantation when compared with controls.
authors.affiliation: Sibley Heart Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia 30322, USA. mahlew@kidsheart.com <mahlew@kidsheart.com>
authors.forename: William T
authors.initials: WT
authors.lastname: Mahle
authors.forename: Brian M
authors.initials: BM
authors.lastname: Cardis
authors.forename: Diana
authors.initials: D
authors.lastname: Ketchum
authors.forename: Robert N
authors.initials: RN
authors.lastname: Vincent
authors.forename: Kirk R
authors.initials: KR
authors.lastname: Kanter
authors.forename: Derek A
authors.initials: DA
authors.lastname: Fyfe
mesh_terms: D000293:Adolescent; D001783:Blood Flow Velocity / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015150:Echocardiography, Doppler / Q000379:methods*; D006321:Heart / Q000503:physiopathology; D016027:Heart Transplantation / Q000502:physiology*; D006801:Humans; D007223:Infant; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology*; D013997:Time Factors; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology