Out of hospital cardiac arrest - a cardiologist perspective
Presentation11
1. Echo in cardiac transplantation.
• Echo plays a vital though often misunderstood
role in the area of cardiac transplanation.There
are often two mutual issues going on when
discussing cardiac transplantation.
• The donor heart must be fully assessed for any
abnormalities such as cad, valve disorders, etc. A
critical area for the surgical team is the condition
of the coronary arteries.
2. Echo in cardiac transplantation.
• The second area is if the recipient of the
donor heart does not reject the implanted
heart. Echo is vital to assess if there is any
rejection along with other laboratory data.
• This PowerPoint will address all of these issues
in great detail.
5. Founders of Surgery.
• The first human heart transplant was in South
Africa by Dr. Christian Barnard in 1967.
• Dr.Norman Shumway did most of the research on
the surgery in Stamford University.
• The key tipping point for the surgery to happen
on routine basis was the development of
medicine to prevent rejection of the implanted
heart.
6. Transplantation caveats.
• Heart donor storage is a big problem since
patients often on waiting list have 7.3% death
rate and average wait time is 24 to 36
months(Mondillo 2008).
• Coronary arteries of a donor hear must have
mild disease for transplantation to
proceed(Mondillo 2008).
7. Echo role
• Echo plays a unique role in cardiac
transplantation.Echo is used often to assess
multifactorial things in a transplanted heart.
• The gold standard when assessing rejection of
a transplanted heart is a right ventricle
biopsy(Roshanali 2010).
• Recent research has centered on developing a
echo rejection score(Roshanali 2010).
8. Echo rejection score.
• Recent studies have begun to correlate echo
indices versus myocardial biopsy's.
• All three myocardial segments were
measured RV base,septal base, and lateral left
ventricle base.Also, lateral left ventricle base,
systolic strain were measured(Roshanali
2010).
• Time to systole was measured in three
segments RV-TS,Sep TS, Lateral TS.
10. Echo rejection score.
• The new formula has an area under the curve
of 09.32 and a cut off point of 0 ,it yields a
sensesevity of 100 % ,specificity of
71.0,postive predictive value of 68% and
negative predictive value of 100%(Roshanali
,2010).
11. Things to focus on.
• When doing a echo to assess for cardiac
rejection the sonogrpaher needs to focus on a
few key things.
• 1.left ventricle mass.
• 2.Valve performance.
• 3.Right and left ventricle function.
• 4. TDI.
12. Caveats.
• Severe left ventricle hypertrophy has been
shown to predict mortality at 1 year follow up
in HT patients(Mondillo, 2008).
• Dobutamine stress echo is often used to
assess a HT patients hear performance .A
normal DSE predicts an uneventful clinical
course and justifies postponement of invasive
studies(Mondillo, 2008).
13. TDI.
• Tissue Doppler imaging has begun to play a
larger role in evaluating hearts after
transplantation.
• Integrated back scatter appears able to
identify AAR by the decrease of cyclic
variation signal and the increase of 2d derived
end diastolic IBS signal of either posterior or
septal wall(Mondillo ,2008).
14. 3D echo.
• 3D echo also will play a much larger role in
assessing cardiac transplantation patients in
the near future. Recent studies has confirmed
3D echo cardiac output numerical values
correlate well with MRI derived data(Holland
2007). Cardiac MRI is still considered to be the
gold standard for assessing hemodynamic
data.
16. References.
• Monodillo,S.(2008).Usefulness and limitations
of 2D echo in heart transplantation recipients.
from www.cardiovascular ultrasound .com
• Hoole,Stephen.Boyd,James.(2007).Cardiac
output by 3d echo for patients undergoing
assessment for cardiac transplantation.EHJ
Cardiovascular imaging.9(3).334-337.
