Two-Dimensional Echocardiography Detects Transient Right Ventricular Dysfunction After Cardiac Transplantation

Right ventricular dysfunction may occur soon after cardiac transplantation. Factors suggested to be responsible for right ventricular dysfunction include prolonged transplantation ischemic time, pulmonary hypertension, or early rejection. Right ventricular and left ventricular fractional area change (FAC) and ejection fraction (EF) were prospectively measured by two-dimensional (2D) echocardiography 2 days after transplantation (while under inotropic support) and at discharge (mean day 19, range 9-60) in 18 patients by the area-length method. A significant increase in right ventricular FAC (0.38 ± 0.08 to 0.44 ± 0.06, P = 0.025) and right ventricular EF (0.53 ± 0.08 to 0.60 ± 0.08, P = 0.015) was observed at discharge compared to day 2. Left ventricular FAC and EF did not change significantly (0.43 ± 0.07 to 0.40 ± 0.06 and 0.61 ± 0.09 to 0.56 ± 0.07, respectively). Right ventricular FAC (< 0.35) and right ventricular EF (< 0.45) was impaired in 4 patients (22%) 2 days after transplantation (all had normal left ventricular function) but normalized by discharge. There was no correlation between right ventricular function and donor ischemic time, hemodynamics, or early rejection (one patient). Only one patient died before discharge (with normal right ventricular and left ventricular function). Impaired right ventricular function after cardiac transplantation is transient, associated with normal left ventricular function, and may be related to inadequate right ventricular myocardial preservation. Right ventricular function improves in nearly all patients by discharge.