Donor Heart Transplant

And Artificial Heart Placement

Donor Heart Transplant or artificial heart placement is needed when the individual’s heart becomes untreatable, specifically the ventricles are unable to perform efficiently and eventually result in heart failure. Heart transplant from human donors have shown promising results. However, the supply of viable human hearts is easily overwhelmed by the demand for heart recipients. Sometimes, artificial heart placement is being performed to prolong the life of the recipient while waiting for a donor heart. However, most cases of artificial heart transplant remain permanent because of the long wait list of recipients.

Heart Transplant becomes imperative if the recipient heart becomes untreatable medically and surgically. Candidates for transplant exhibit signs and symptoms of heart failure.

Symptoms of Heart Failure

Individuals with chronic and congestive heart failure exhibit the following symptoms.

  • Chest discomfort and pain
  •  Periorbital swelling (puffy eyelids)
  •  Swelling of abdomen and extremities
  •  Shortness of breath
  •  Cyanosis
  •  Easily fatigued
  •  Edema (swelling of hands, feet and ankles)
  •  Pallor (due to anemia)
  •  Fainting (Syncope)

Diagnosis of Heart Failure

The following standard diagnostic tests are performed as an integral part of the cardiac work up before a heart transplant is performed.

History Intake through a Q and A with Your Doctor and Physical Examination should reveal the likelihood of long term survival for individuals in need of transplant. Mental state is also important pre-operatively.

Electrocardiography (ECG/EKG) – This procedure is performed on the donor’s and recipient’s heart. The procedure involves placing of electrodes on the body and determines the polarity of heart’s discharges. Physicians can determine the speed of and rhythm of the heart. This will also serve as a baseline for determining the viability of the heart.

Echocardiography – Utilizes sound waves to elucidate the image of the heart real time to show the size and the shape of the heart. Echocardiography can measure the ejection fraction of the heart. In cases of cardiac failure, ejection fraction is expected to be grossly insufficient and limited.

Chest X-Ray – Chest X-rays uses ionizing radiation to take pictures of the inside of the chest cavity. X-Ray may reveal enlargement of the heart, deviation from normal anatomy of the heart and the accumulation of fluid in the heart and chest cavity. Individuals with congestive heart failure will show a large dilated heart to the left of the apex.

Computed Tomography (CT) – This will involve several x-ray shots to view the heart and lungs in all angles and expose the defect. Ventricles may appear over-dilated in the CT slides.

Magnetic Resonance Imaging (MRI) –Cardiac MRI utilizes magnet, radio waves and computer to diagnose defects of the heart. MRI can give three dimensional imaging, either static or moving. Cardiologist can easily see the behavior of the heart during actual pumping and how the defective walls compromise the blood flow. Ejection fraction may be computed to assess the viability of the myocardium. The severely dilated heart will appear to be inefficient in pumping out blood for circulation.

Cardiac Catheterization – This is an invasive procedure whereby a flexible plastic tube is inserted in a big vessel of the thigh, arm or neck, and threaded to the heart. Dyes may be injected in certain areas for clearer x-ray shots; this is known as cardiac angiography. Ventricular chambers may be elucidated and seen more clearly.

Special Considerations

Heart transplantation, as with all other transplants, has the possibility of organ rejection. For this reason, heart transplant recipients are given immune suppressant drugs to reduce rejection by what is known as the host. The use of immune suppressants may induce cancer growth in select individuals and may produce severe infections in certain individuals. There are numerous other risks that your physician will review with you before the procedure.  Although heart transplantation is a lifesaving operation, the inherent risks must be understood and the development of coping skills may be required following transplantation.

Adjuncts to Treatment

The following treatments are given to individuals before and after a heart transplant.

Heart Medications – Heart medications like beta blockers, calcium channel blockers and digoxin are given to patient to prevent progression to end stage heart failure prior to the operation.

Digoxin – Digoxin drips may be given post operatively to support the new heart temporarily until the individual is stable enough to be weaned.

Anti-Rejection Medications – Immune suppressants like cyclosporine, tacrolimus, azathioprine and prednisone are commonly given to prevent organ rejection by the body after the transplant procedure. Some of these medications may be continued as a maintenance treatment over a lifetime.

Outcome

There have been a good number of heart transplant recipients who have been discharged from the hospital, have become immersed in society and have lived a quality life for several years thereafter. The success of the whole procedure greatly rests on the individual as soon as he or she is wheeled out of the operating room. Individuals that have heart transplants are expected to work with the transplant’s team nutritionist, physical therapist, and respiratory therapist while in the hospital. Upon discharge, these individuals should take anti-rejection medications as required, visit their cardiologist and transplant surgeon regularly and report untoward symptoms post operatively.  The good news is that those who survive may continue on with an enhanced quality of life.  

It is important to recognize that medications and medical procedures are associated with benefits and risks that should be discussed with your physician. It is important to recognize that all information contained on this website cannot be considered to be specific medical diagnosis, medical treatment, or medical advice. As always, you should consult with a physician regarding any medical condition.
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