Heart transplantation: echocardiographic assessment of morphology and function after more than 10 years of follow-up

Background. Over recent years, heart transplantation (HTX) developed into a successful option for long-term treatment of end-stage heart failure. Ten-year survival ranges between 40% and 50%. Little is known, however, about function and morphology of transplanted hearts during follow-up of more than 10 years. Methods. In a consecutive cohort of 65 patients (55 male, 54.6 ± 12.1 years at the time of transplantation), graft function was assessed by color Doppler echocardiography 12.5 ± 1.4 years after heart transplantation (10 to 15 years). Results. Left atrial and ventricular dimensions were found in a normal range (LA 37.7 ± 8.9 mm, LV enddiastolic 45.6 ± 6.4 mm, 30 to 71 mm). Ejection fraction (EF) of 71 ± 11.7% and a fractional shortening of 35.3 ± 10.3% presented with normal values. Left ventricular mass (male 263.8 ± 111.4 g, female 373.0 ± 181.1 g) was slightly increased resulting in mild hypertrophy in women. Focused on right ventricular morphology, enlargement of both the right atrium and the right ventricle (RA 40.7 ± 11.8 mm, RV 37.4 ± 8.3 mm) was observed in the majority of the patients. Tricuspid valve insufficiency (> grade II) was present in 46 of 65 patients; 5 patients had previously undergone tricuspid valve replacement. Atrial filling waves were detectable in only 47 of 65 patients, thus, 28% of patients showed signs of LA-dysfunction. Conclusions. More than 10 years post-HTX, cardiac grafts were characterized by normal left ventricular dimensions and ejection fraction. LA-dysfunction and RV-enlargement associated with tricuspid insufficiency were frequent findings, however, not associated with clinical signs of congestive heart failure in the majority of patients.