Faculty Collaboration Database

Evaluation after Orthotopic Heart Transplant: What the Radiologist Should Know. Radiographics 2019;39(2):321-343

Date

02/09/2019

Pubmed ID

30735469

DOI

10.1148/rg.2019180141

Scopus ID

2-s2.0-85062611512 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

Orthotopic heart transplant (OHT) is the treatment of choice for end-stage heart disease. As OHT use continues and postoperative survival increases, multimodality imaging evaluation of the transplanted heart will continue to increase. Although some of the imaging is performed and interpreted by cardiologists, a substantial proportion of images are read by radiologists. Because there is little to no consensus on a systematic approach to patients after OHT, radiologists must become familiar with common normal and abnormal posttreatment imaging features. Intrinsic transplant-related complications may be categorized on the basis of time elapsed since transplant into early (0-30 days), intermediate (1-12 months), and late (>12 months) stages. Although there can be some overlap between stages, it remains helpful to consider the time elapsed since surgery, because some complications are more common at certain stages. Recognition of differing OHT surgical techniques and their respective postoperative imaging features helps to avoid image misinterpretation. Expected early postoperative findings include small pneumothoraces, pleural effusions, pneumomediastinum, pneumopericardium, postoperative atelectasis, and an enlarged cardiac silhouette. Early postoperative complications also can include sternal dehiscence and various postoperative infections. The radiologist's role in the evaluation of allograft failure and rejection, endomyocardial biopsy complications, cardiac allograft vasculopathy, and posttransplant malignancy is highlighted. Because clinical manifestations of disease may be delayed in transplant recipients, radiologists often recognize postoperative complications on the basis of imaging and may be the first to suggest a specific diagnosis and thus positively affect patient outcomes. Online supplemental material is available for this article. ^©RSNA, 2019.

Author List

Smith JD, Stowell JT, Martínez-Jiménez S, Desouches SL, Rosado-de-Christenson ML, Jain KK, Magalski A

Author

Stephane Desouches DO Vice Chair, Associate Professor in the Radiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Echocardiography
Female
Graft Rejection
Heart
Heart Transplantation
Humans
Male
Myocardium
Pericarditis
Postoperative Complications
Postoperative Period
Radiography
Thoracic Neoplasms
Tomography, X-Ray Computed