Beurteilung eines potenziellen Herz-Organspenders : Eine Übersichtsarbeit mit besonderer Beriicksichtigung echokardiographischer Aspekte

Beyond obtaining adequate background data, physical examination, an electrocardiogram, and various serology results, echocardiography is of major importance in the evaluation of the potential cardiac donor. For many reasons echocardiography is the optimal method of imaging a potential donor heart. It provides an accurate assessment of structural abnormalities such as left ventricular hypertrophy, valvular and congenital heart disease. Furthermore, global left ventricular contractile function as well as regional wall motion abnormalities can be assessed. Left ventricular dysfunction is a common finding in patients with brain stem death and the main cause of low donor yield. Regional wall motion abnormalities do not correspond to a coronary perfusion territory, and left ventricular dysfunction may be reversible over time. Functional recovery can be achieved by hemodynamic and metabolic management strategies and should be monitored by serial echocardiography. Given the continuing shortage of available donor hearts, echocardiography may aid to improve the successful utilisation of potential cardiac donors. In most patients transthoracic echocardiography will provide sufficient information. However, in selected cases transesophageal echocardiography or intravenous injection of ultrasound contrast agents will be necessary to acquire high-quality images. Whether or not coronary angiography should be performed in a potential cardiac donor, predominantly depends on donor age, sex, and risk factors for coronary artery disease. Moreover, availability of angiography and urgency status of the recipient should be factored into this decision.