Echocardiographic assessment of mechanical circulatory support and heart transplant

Echocardiography plays a pivotal role in the pre-operative assessment, post-operative management, and long-term follow-up of pediatric heart failure and heart transplant patients. Echocardiography may be a particularly useful modality for evaluating ventricular function and for providing noninvasive rejection surveillance. Mechanical circulatory support has an ever increasing role in heart failure management among pediatric patients. Echocardiography provides a non-invasive tool for assessment of cannula placement, ventricular function, optimization of the device, and routine surveillance for valve regurgitation, estimated pulmonary pressures, pericardial effusion, and thrombus formation while on mechanical support. Heart transplant is the ultimate management option, for those that qualify with end stage heart failure. Heart transplant recipients require frequent echocardiograms for the routine evaluation of the intracardiac structure, ventricular function, surveillance for rejection, as well as direct visualization of the myocardium during endomyocardial biopsy. Below we provide a review for clinicians and sonographers about the importance of echocardiography in the evaluation and management of mechanical circulatory support and heart transplant in children.