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  • Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37:2129–2200.

  • Echocardiography is the most useful, widely available test in patients with suspected heart failure to establish the diagnosis.

  • It provides immediate information on chamber volumes, ventricular systolic and diastolic function, wall thickness, valve function, and pulmonary hypertension.

  • This information is crucial in establishing the diagnosis and in determining appropriate treatment.

  • Kelder JC, Cramer MJ, Van WJ, et al. The diagnostic value of physical examination and additional testing in primary care patients with suspected heart failure. Circulation. 2011;124:2865–2873.

  • Stainback RF, Estep JD, Agler DA, et al. Echocardiography in the management of patients with left ventricular assist devices: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2015;28:853–909.

  • Comprehensive document.

  • Use the table of contents to find the appropriate echocardiography protocol.

  • Pre-implant echocardiographic red flags.

  • Post-implant complications and sonographer checklists.

  • Start by looking at the figures and key points.


  • The biatrial surgical transplant technique (Fig. 6-1) is being replaced by the bicaval technique: superior and inferior cava anastomosis with left atrial excision to the base of the left atrial appendage.

  • Advantages:

    • - Right atrial size remains small.

    • - There is less tricuspid regurgitation.

    • - Less likelihood of need for a post-op pacemaker.

    • - Atrial filling pressures tend to remain normal.

  • Stress echo can help with pretransplant donor heart selection.

  • Following transplantation:

    • - Right ventricular: TAPSE, S’, strain, and fractional area change can remain lower than normal.

    • - 3D echo can be used to guide myocardial biopsy while imaging the tricuspid valve.


The atrial suture line can be demonstrated on the echo of some heart transplant patients.


  • Badano LP, Miglioranza MH, Edvardsen T, et al. Recommendations for the use of cardiac imaging to assess and follow patients after heart transplantation. Eur Heart J Cardiovasc Imaging. 2015;16:919–948.

  • Bhatia SJ, Kirshenbaum JM, Shemin RJ, et al. Time course of resolution of pulmonary hypertension and right ventricular remodeling after orthotopic cardiac transplantation. Circulation. 1987;76:819–826.

  • Costanzo MR, Dipchand A, Starling R, et al. The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J Heart Lung Transplant. 2010;29:914–956.

  • Ingvarsson A, Werther Evaldsson A, Waktare J, et al. Normal reference ranges for transthoracic echocardiography following heart transplantation. J Am Soc Echocardiogr. 2018;31:349–360.

  • Jacob S, Sellke F. Is bicaval orthotopic heart transplantation superior to the biatrial technique? Interact Cardiovasc Thorac Surg. 2009;9:333–342.

  • Leone O, Gherardi S, Targa L, et al. Stress echocardiography as a gatekeeper to donation in aged marginal donor hearts: anatomic and pathologic correlations of abnormal stress echocardiography results. J Heart Lung Transplant. 2009;28:1141–1149.

  • Nguyen V, Cantarovich M, Cecere R, et al. ...

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