Evaluation after Orthotopic Heart Transplant: What the Radiologist Should Know.

Area of Science:

• Radiology
• Cardiology
• Transplant Medicine

Background:

• Orthotopic heart transplant (OHT) is a primary treatment for end-stage heart disease.
• Increasing OHT use and survival necessitate comprehensive imaging evaluation of transplanted hearts.
• Radiologists interpret a significant portion of OHT imaging, requiring expertise in post-transplant features.

Purpose of the Study:

• To provide radiologists with a systematic approach to imaging evaluation after OHT.
• To familiarize radiologists with common normal and abnormal post-transplant imaging findings.
• To highlight the radiologist's role in identifying early and late OHT complications.

Main Methods:

• Categorization of intrinsic transplant-related complications by time elapsed since transplant: early (0-30 days), intermediate (1-12 months), and late (>12 months).
• Recognition of differing OHT surgical techniques and their associated postoperative imaging features.
• Review of expected early postoperative findings and potential complications.

Main Results:

• Early postoperative findings include pneumothoraces, pleural effusions, pneumomediastinum, pneumopericardium, atelectasis, and enlarged cardiac silhouette.
• Early complications can also involve sternal dehiscence and infections.
• Radiologists are vital in detecting allograft failure, rejection, and other complications, often before clinical manifestation.

Conclusions:

• A systematic approach to OHT imaging is crucial for radiologists due to the lack of consensus.
• Understanding temporal patterns of complications aids in accurate diagnosis.
• Radiologists' imaging expertise significantly impacts patient outcomes by enabling early diagnosis and intervention.