Valvular regurgitation and right-sided cardiac pressures in heart transplant recipients by complete Doppler and color flow evaluation

Abstract

Objective: To define normal profiles of cardiac structure, function, and hemodynamics postcardiac transplantation using Doppler echocardiography.

Design: Retrospective clinical case series with mean follow-up of 5.1 months.

Setting: Institutional tertiary care center, ambulatory setting.

Patients: A consecutive sample of 48 orthotopic cardiac transplant recipients.

Results: Aortic regurgitation was present in two patients, and was trivial in both cases. Mitral regurgitation was present in 29 of 48 patients, was trivial in 19 of 29 patients, and was mild in 10 of 29 patients. Tricuspid regurgitation was present in 41 of 48 patients and was graded as follows: trivial, 23 of 41; mild, 12 of 41; and moderate, 6 of 41. Septal hypokinesis was present in 33 of 49 patients, and no patient had evidence of other wall motion abnormalities. A pericardial effusion was present in 13 of 48 patients. Hemodynamic values were comparable to those of a nontransplant, normal population with pulmonary artery systolic pressures having a mean value of 31 +/- 6 mm Hg (range, 15 to 45 mm Hg) and estimates of right atrial pressure being 0 to 5 mm Hg in 12 of 48, 5 to 10 mm Hg in 32 of 48, and 10 to 15 mm Hg in 1 patient. There was no correlation between the degree of mitral or tricuspid regurgitation and sex, transplant interval, hemodynamic indices, or endomyocardial biopsy specimen grade. Right ventricular enlargement was associated with the presence of moderate tricuspid regurgitation.

Conclusions: Cardiac transplantation recipients commonly display the following: (1) trivial or mild degrees of mitral regurgitation; (2) as much as moderate tricuspid regurgitation; (3) septal hypokinesis; and (4) small pericardial effusions. There is an association between the presence of right ventricular enlargement and moderate tricuspid regurgitation.