Abnormal Surveillance Echo Parameters Following Orthotopic Heart Transplantation

IntroductionAfter manipulation of the native pericardium and transplantation a donor heart during orthotopic (OHT), diagnosis constrictive restrictive pathologies becomes challenging.Case ReportA 37-year-old man, with history dilated cardiomyopathy presented for one-year follow-up after OHT routine care. He had no dyspnea, fatigue, or edema. Transthoracic echocardiography (TTE) showed ejection fraction 60%. Significant parameters included abnormal septal bounce (Fig 1A), E/A 3.7, E/E’ 43 greater than lateral E’ velocity 1C). There was pericardial thickening effusion 1B). Cardiac catheterization evidence cardiac allograft vasculopathy, hemodynamics prominent Y blunted X descents 1D). Simultaneous tracings right left ventricles were not consistent constriction 1E). Endomyocardial biopsy did show rejection.SummaryThere are formal guidelines endorsed by American Society Echocardiography to distinguish “normal variant” transplanted from pathological disease state following OHT. Mitral annular velocities can reduce surgery. Additionally, hearts younger patients display elevated E/A. These findings suggest diastolic dysfunction filling pattern. In our case, patient motion TTE suggesting mixed pattern however invasive hemodynamic assessment inconclusive an absolute diagnosis. absence symptoms stable graft function further work up performed. When assessing surveillance echocardiogram OHT, characteristics may result in echo without pathology. Providers should consider normal variant their differential when echocardiograms After challenging. A rejection.