Serial echocardiographic findings early after heart transplantation: Evidence for reversible right ventricular dysfunction and myocardial edema

Serial M-mode and two-dimensional echocardiograms were performed on 10 patients at 1 week, 1 month, and 3 months after heart transplantation to determine early structural and functional changes in the allograft. Standard M-mode echocardiographic measurements of at least five cardiac cycles were averaged. Right ventricular size and function were assessed by mid-ventricular diameter and the right ventricular apex to lateral tricuspid anulus shortening fraction, respectively, on the two-dimensional apical four-chamber view. There were no consistent differences in left ventricular end-diastolic dimension or fractional shortening between study periods. Left ventricular posterior wall thickness decreased from 15 ± 2 to 11 ± 1 mm (p = 0.0001), and septal thickness decreased from 15 ± 2 to 12 ± 2 mm (p = 0.0006) between the 1-week and 3-month studies. Right ventricular cross-sectional dimension increased from 34 ± 6 to 39 ± 6 mm (p = 0.047), and right ventricular fractional shortening increased from 13% ± 3% to 21% ± 5% (p = 0.0051) between the 1-week and 3-month studies. There were no correlations between any of the above changes and rejection episodes. There was a weak correlation (r = 0.53) between ischemic time and change in posterior wall thickness. Right ventricular dysfunction and increased left ventricular wall thickness presumably caused by interstitial edema appear to be normal findings early after heart transplantation.