The right ventricle of transplanted hearts at 2,640 meters above sea level. A latin-american experience




Juan F. Vasquez-Rodriguez, Department of Cardiology, Fundación Cardioinfantil Instituto de Cardiología, Universidad El Bosque, Faculty of Medicine and Health Sciences, Bogota D.C, Colombia
Ramón Medina-Mur, Department of Cardiology, Fundación Cardioinfantil Instituto de Cardiología, Universidad El Bosque, Faculty of Medicine and Health Sciences, Bogota D.C, Colombia
Luis E. Giraldo, Department of Cardiology, Universidad del Rosario School of Medicine and Health Sciences, Bogota D.C, Colombia
Claudia Jaimes, Division of Cardiovascular Imaging, Department of Cardiology, Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
Monica Lopez, Division of Heart Failure and Transplant, Department of Cardiology, Fundación Cardioinfantil Instituto de Cardiología. Bogota D.C, Colombia
John Ramirez, Division of Heart Failure and Transplant, Department of Cardiology, Fundación Cardioinfantil Instituto de Cardiología. Bogota D.C, Colombia
Ma Juliana Rodriguez, Division of Heart Failure and Transplant, Department of Cardiology, Fundación Cardioinfantil Instituto de Cardiología. Bogota D.C, Colombia


Background: High-altitude cardiovascular adaptations increase lung pressure. This effect on the right ventricle (RV) of transplanted hearts at altitudes above 2,500 meters above sea level (masl) has not been described. Objective: The objective of the study was to describe echocardiography RV behavior in the immediate post-operative period (Days 1-7 post-Heart transplant [HTx]), 3, 6, 12, and 24 months after HTx in patients at 2640 masl. Methods: Historical cohort of HTx patients in the period between 2005 and 2019, in a hospital located in Bogotá, Colombia. Socio-demographic, clinical, and echocardiographic evaluation data of the RV at 5 follow-up moments were analyzed. Results: 91 patients underwent HTx, 64% remained at a height > 2500 masl in the post-operative period. Transthoracic echo was available in 37 patients (40.6%). Right ventricular dysfunction was found in 95% of patients, which was predominantly moderate (43%), with improvement 3 months after transplant. The immediate post-operative Tricuspid annular plane systolic excursion was 8.9 ± 4.9 mm, with recovery from the 3rd post-operative month (15.1 ± 3.6 mm) and without significant changes in month 24 (15.8 ± 4.9 mm). Immediate post-operative systolic pulmonary artery pressure (sPAP) was 39.2 ± 8.2 mmHg, showing a decrease at 24 post-operative months (31.0 ± 5.0 mmHg). The 5-year survival was 78% Confidence Interval 95% 60-85. Conclusion: After HTx, most patients present right ventricular dysfunction, improving at the 3rd month of transplant. There were no significant differences between patients living at more than 2500 masl and < 2500 masl.



Keywords: Heart transplant. Right ventricular dysfunction. Pulmonary hypertension. High altitude.