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Echocardiographic evaluation of left ventricular wall motion before and after heart transplantation
1Department of Internal Medicine Cardiology, University Hospital, Zurich, Switzerland.
Insights
Brain-dead heart donors frequently exhibit left ventricular wall motion abnormalities. Two-dimensional echocardiography effectively detects these issues, which improve post-heart transplantation.
Area of Science:
- Cardiology
- Transplant Surgery
- Medical Imaging
Background:
- Brain death can lead to myocardial dysfunction.
- Left ventricular wall motion abnormalities (LVWMA) are common in potential heart donors.
- Early detection of LVWMA is crucial for successful heart transplantation.
Purpose of the Study:
- To investigate the prevalence and course of LVWMA in brain-dead heart donors.
- To assess the efficacy of two-dimensional echocardiography in detecting and quantifying LVWMA.
- To evaluate the changes in LVWMA before and after heart transplantation.
Main Methods:
- Retrospective analysis of 40 heart transplant recipients.
- Two-dimensional echocardiography performed before, immediately after, and 15 months post-transplant.
- Quantitative assessment of myocardial wall motion using a modified score index system.
Main Results:
- 27 of 40 donors (67.5%) showed LVWMA.
- Wall motion abnormalities significantly improved immediately after transplantation (score index: 0.36 vs 0.18, p < 0.01).
- Improvements were sustained at 15 months post-transplant (score index: 0.15), with exceptions in one group.
Conclusions:
- Brain-dead potential heart donors often present with LVWMA.
- Two-dimensional echocardiography is a valuable tool for detecting and quantifying these abnormalities.
- LVWMA in heart donors show significant improvement post-transplantation, supporting donor heart viability.
Abstract:
Forty transplanted hearts were retrospectively investigated before, immediately after, and 15 +/- 12 months after heart transplantation by two-dimensional echocardiography for the presence and course of left ventricular myocardial wall motion abnormalities. Fourteen heart donors who were brain dead because of subarachnoid hemorrhage formed group 1 (mean age, 35 years); 21 heart donors who were brain dead because of head injury formed group 2 (mean age, 29 years), and five heart donors who were brain dead because of head injury with an additional chest trauma formed group 3 (mean age, 28 years). Myocardial wall motion was examined in six different myocardial segments (inferior, septal, anterior, posterior, posterolateral, apical) and was quantitatively assessed by a modified score index system (score index 0 = normal wall motion; score index 1 = diffuse hypokinesia). Overall, 27 of the 40 heart donors showed mild to severe (9 of the 40) wall motion abnormalities, which improved shortly after heart transplantation (score index: 0.36 vs 0.18, p < 0.01), and remained improved 15 months after heart transplantation (score index: 0.15). Among the different study groups, a significant improvement occurred in the myocardial wall motion score index on a short-term and long-term basis in all the groups, except for group 2, regarding the long-term follow-up. This study concluded that brain-dead, potential heart donors often reveal mild-to-severe left ventricular wall motion abnormalities, which are readily detected and semiquantitated by two-dimensional echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)