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[Transesophageal echocardiographic findings in patients after heart transplantation]
N Ishizuka1, K Nakamura, Y Fujita
1Department of Cardiology, Heart Institute of Japan, Tokyo Women's Medical College.
Insights
Transesophageal echocardiography (TEE) is valuable for monitoring heart transplant recipients. It helps detect thrombus and assess blood flow in pulmonary veins and the left atrial appendage post-transplantation.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Heart transplantation is a critical treatment for end-stage heart failure.
- Monitoring transplant recipients is essential to detect complications early.
- Transesophageal echocardiography (TEE) offers detailed cardiac imaging.
Observation:
- This study investigated TEE's diagnostic utility in five heart transplant recipients (four orthotopic, one total).
- TEE identified donor-recipient atrial anastomosis in orthotopic transplants but not total transplants.
- No thrombus or spontaneous echo contrast was detected by TEE or transthoracic echocardiography.
Findings:
- Color Doppler TEE revealed trivial mitral regurgitation in all patients.
- The patient with total heart transplantation showed pulmonary vein flow velocity differences, suggesting potential suture line stenosis or external compression.
- TEE effectively evaluated flow patterns in pulmonary veins and the left atrial appendage, identifying abnormal atrial flow.
Implications:
- Transesophageal echocardiography is a useful tool for the follow-up of heart transplant recipients.
- TEE aids in the early detection of potential complications like thrombus formation and flow abnormalities.
- This imaging modality enhances the comprehensive assessment of cardiac function and structure after heart transplantation.
Abstract:
The diagnostic value of transesophageal echocardiography was investigated in heart transplant recipients, i.e., four patients who received orthotopic heart transplantation and one patient who received total heart transplantation. Donor-recipient atrial anastomosis was identified in the four patients with orthotopic heart transplantation, but not in the patient with total heart transplantation. Transthoracic and transesophageal echocardiography detected no thrombus or spontaneous echo contrast in any of the patients. Color Doppler transesophageal echocardiography showed trivial mitral regurgitation in all patients. Total heart transplantation resulted in no protruding suture line and normal atrial cavity size. The patient with total heart transplantation showed some difference in the peak flow velocity of the right and left pulmonary veins (left superior pulmonary vein: 48 cm/sec; right superior pulmonary vein: 86 cm/sec), possibly due to stenosis at the suture line between the left atrium and right superior pulmonary vein, or compression of the right superior pulmonary vein by the anastomosis between the superior vena cava and right atrium. Transesophageal echocardiography was helpful for detecting thrombus in the left atrium and left atrial appendage after heart transplantation, and allowed evaluation of the flow pattern in the pulmonary veins and left atrial appendage as well as abnormal flow in the atrium. In conclusion, transesophageal echocardiography is useful in the follow-up of heart transplant recipients.