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Echocardiography

Echocardiography. Post Cardiac Transplant Surgery. Post-Cardiac-Transplant Surgery. Goal Assessment of cardiac anatomy and physiology. Noninvasive early diagnosis of transplant rejection. Diagnosis of post transplant Coronary artery disease. Post-Cardiac-Transplant Surgery.

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Echocardiography

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  1. Echocardiography Post Cardiac Transplant Surgery

  2. Post-Cardiac-Transplant Surgery Goal • Assessment of cardiac anatomy and physiology. • Noninvasive early diagnosis of transplant rejection. • Diagnosis of post transplant Coronary artery disease

  3. Post-Cardiac-Transplant Surgery Clinical Problems Encountered • Pericardial effusion • RV systolic dysfunction • LV systolic dysfunction

  4. RV Systolic Dysfunction • Inadequate myocardial preservation at time of transplantation. • Persistently elevated pulmonary vascular resistance. • Transplant rejection.

  5. LV Systolic Dysfunction • Inadequate myocardial preservation at time of transplantation. • Acute rejection. • Superimposed Coronary artery disease.

  6. Regurgitation MR and TR Occurs secondary to: 1. Ventricular dysfunction 2. Annular dilation

  7. Post-Cardiac-Transplant Surgery Findings in the uncomplicated Patient • Normal RV and LV size and wall thickness. • Normal systolic function.

  8. Post-Cardiac-Transplant Surgery • Normal valvular anatomy and function – may have small amount of TR, MR and PR (prevalence similar to that in normal individual). • Abnormal septal motion is the norm.

  9. Post-Cardiac-Transplant Surgery • Small Pericardial effusion (few weeks) • Persistently elevated PAP • Biatrial enlargment • Atrial suture line

  10. Post-Cardiac-Transplant Surgery

  11. Post-Cardiac-Transplant Surgery

  12. Post-Cardiac-Transplant Surgery

  13. Post-Cardiac-Transplant Surgery Abnormal Septal Motion • Anterior motion of the septum in systole. • Reduced systolic thickening of the septal myocardium.

  14. Echo Approach • Similar to any patient • Look for suture line • Expect abnormal septal motion • Search for loculated pericardial effusion

  15. Transplant Rejection • Increased LV mass • Decrease in systolic function • An increase in the echogenicity of the myocardium

  16. Post-Cardiac-Transplant Surgery Transplant Rejection associated with • Restrictive ventricular filling pattern. • Decreased IVRT • Increased E wave • Decreased A wave • Shortened PHT • Loss of forward systolic flow in the SVC

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