Skip to Main Content

CHAPTER 6: Heart Failure

GUIDELINES Source

  • 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.

Sources

  • 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.

HEART TRANSPLANTATION

  • 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.

FIGURE 6-1

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

An echocardiogram of the heart shows a large darker area inside the bright white bands representing the atrial suture line.
View Full Size||Download Slide (.ppt)

Sources

  • 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. ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MH Privacy Center Close