QUANTITATIVE ASSESSMENT OF VALVULAR FUNCTION AFTER CARDIAC TRANSPLANTATION BY PULSED DOPPLER-ECHOCARDIOGRAPHY

In 31 patients who had undergone cardiac orthotopic transplantation, valvular regurgitation was studied by echocardiographic and pulsed Doppler over 2 years. The first week after cardiac transplantation, transplant recipients had an increase in the severity of tricuspid, mitral (group II), and aortic regurgitation, as well as a greater number of simultaneously regurgitating valves when compared with those in a group of 60 normal subjects of similar age to heart donors: transplant recipients, trivalvular regurgitation 48% (95% confidence interval [CI] 30 to 66) vs control group, 5% (CI 1 to 13; p <0.001). Moderate-severe tricuspid regurgitation (TR) was the most frequent occurrence (55%, CI 36 to 73) followed by pulmonary (PR) (42%, CI 25 to 61), moderate mitral (MR) (32%, CI 15 to 51), and mild aortic (AR) (23%, CI 10 to 43) regurgitation. These regurgitations were asymptomatic at rest except for TR. TR was associated with right-sided heart failure in 76% of patients In the early postoperative period and controlled with diuretic drugs. This regurgitation correlated with persistence of post-transplant pulmonary hypertension (r = 0.6) and was not related to pulmonary hypertension before cardiac transplant. There was also no relation found between donor ischemia time or episodes of cardiac rejection. The follow-up of these regurgitations decreased significantly during the first months: TR from 55% (CI 36 to 73) to 21% (CI 8 to 40) at 2 months (p <0.05); PR from 42% (CI 26 to 61) to 18% (CI 6 to 36) at 2 months (p <0.01); MR from 29% (CI 14 to 48) to 3% (CI 0 to 18) at 3 months (p = 0.01); and AR from 23% (CI 10 to 43) to 0% (CI 10 to 43) at 3 months (p = 0.01); they did not reappear during the follow-up period.