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Echocardiographic evaluation after pediatric heart transplant in Chile: initial application of a functional protocol
Claudia Trincado1, Víctor Molina2, Gonzalo Urcelay1
1Departamento de Cardiología y Enfermedades Respiratorias, División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile.
Insights
Pediatric heart transplant recipients often show subclinical biventricular systolic dysfunction via echocardiography, even without rejection or pulmonary hypertension. Further follow-up is needed to understand the clinical significance of these findings.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Transplantation Medicine
Background:
- Echocardiography is vital for post-heart transplant monitoring.
- Optimal follow-up protocols require further definition.
Purpose of the Study:
- To assess a functional echocardiographic protocol in pediatric heart transplant patients.
- To evaluate global longitudinal strain and biventricular function.
Main Methods:
- A functional echocardiographic protocol including global longitudinal strain was applied.
- Data included endomyocardial biopsy and hemodynamic parameters.
- Nine pediatric heart transplant recipients were evaluated.
Main Results:
- Most patients exhibited abnormal global longitudinal strain.
- All patients showed right ventricular systolic dysfunction.
- Only one patient had left ventricular systolic dysfunction by classic metrics.
Conclusions:
- Subclinical biventricular systolic dysfunction is common post-pediatric heart transplant.
- No correlation was found with rejection or pulmonary hypertension, possibly due to small sample size and absence of severe rejection.
- Long-term follow-up is essential to determine clinical relevance.
Introduction:
The echocardiographic evaluation of patients after heart transplantation is a useful tool. However, it is still necessary to define an optimal follow-up protocol.
Objective:
To describe the results of the application of a functional echocardiographic protocol in patients being followed after pediatric heart transplantation.
Patients And Method:
Alls patients being followed at our institution after pediatric heart transplantation underwent an echocardiographic examination with a functional protocol that included global longitudinal strain. Contemporaneous endomyocardial biopsy results and hemodynamic data were recorded.
Results:
9 patients were evaluated with our echocardiographic functional protocol. Of these patients, only 1 showed systolic left ventricular dysfunction according to classic parameters. However, almost all patients had an abnormal global longitudinal strain. Right ventricular systolic dysfunction was observed in all patients. No epidodes of moderate to severe rejectiom were recorded. No correlation was observed between these parameters and pulmonary artery pressure.
Conclusions:
Subclinical biventricular systolic dysfunction was observed in the majority of the patients in this study. No association with rejection episodes or pulmonary hypertension was observed, which may be related to the absence of moderate or severe rejection episodes during the study period, and to the small sample size. Long term follow-up of these patients may better define the clinical relevance of our findings.
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