POST TRANSPLANT CARDIOLOGY EVALUATION

CLINICAL VISIT SCHEDULE

1. Every week until 2 months post-transplant:
2. THEN every 2 weeks for 2 months
3. THEN monthly for 6 months (post-transplant)
4. THEN every 4 months after 1-2 years post-transplant
5. > 2 years: every 6 months
6. If patient is changed to monotherapy after 12-month cath, then patient should return in 1 month for a clinic visit to assess for rejection.

Non-compliance with visits: If the family has not made an appointment, PED Coordinator will call to the family and will be contact to Social Services. If the family fails to appear for more than 1 appointments, social services will evaluate medical neglect and appropriate action will be taken.

ECG/HOLTER MONITORING 

1. ECG with each clinic visit
2. Holter recording at 1st annual visit, repeat annually or biennial if abnormal
3. Holter and Stress test annually in patients with CAV
4. When clinically indicated based on abnormal ECG, symptoms, etc.

ECHOCARDIOGRAM 

1. Ecochardiography with each clinic visit (in Echo Lab or Bedside Echo)
2. Notify Echolab at first outpatient echo if patient has additional intracardiac defects related to donor organ, or if patient has vascular stenosis or other anatomic abnormalities that require additional imaging (in case of suspiction of rejection, GLS should be carried out).
3. Check: biventricular function, size chambers and dimension of septum, mitral regurgitation, mitral flow and DTI mitral (ratio E/E’), pericardial effusion, pulmonary pressure and IVC collapsibility.

ACUTE VISIT 

1. Acute outpatient visit: initial testing by PED coordinator triaging call
2. If patient warrants an Emergency Department visit or is hospitalized with an illness, the patient should have an ECHO and ECG at that time to exclude severe rejection (poor LV function). Rare exception includes patient presentation to ER with obvious alternative illness and no signs/symptoms rejection (as infections, see Table below)
3. Additional laboratory work unless patient’s diagnosis is obvious should include: B-type natriuretic peptide, metabolic panel, CBC with differential.