Purpose or Case Report: Orthotopic heart transplant (OHT) is the treatment of choice for patients with end-stage heart disease including pediatric patients. Imaging has an essential role in evaluation of the perioperative and postoperative heart transplant patients. Although some of the imaging is performed and interpreted by cardiologists, a substantial portion of images are read by radiologist, therefore radiologists must be familiar with common normal and abnormal posttreatment imaging features.



Many end stage heart failure patients require circulatory support as a bridge to transplant, with a ventricular assist device or intra-aortic balloon pump. The ventricular assist devices specially increase the risk of infection, and intra-aortic balloon pump requires frequent radiographic monitoring to ensure appropriate placement in the proximal descending aorta, just distal to the left subclavian artery. Proximal placement may result in great vessel compromise and distal placement may cause occlusion of mesenteric and/or renal vasculature.

Expected postoperative findings in the first few weeks after surgery included enlarged cardiac silhouette, small pneumomediastinum, pneumothorax, pneumopericardium, subcutaneous emphysema, small atelectasis, and mediastinal widening.

Transplant-related complications are divide to:
Early complications (0-30 days): pulmonary infection, interstitial and/or alveolar pulmonary edema, and allograft failure, also symptomatic pneumothorax, mediastinal hematoma, mediastinal infection, sternal dehiscence and vascular complications.

Intermediate term complications (1-12 months): acute antibody related allograft rejection, acute cellular rejection (T-cell mediated response) which is the most common form of rejection, also tricuspid regurgitation, constrictive pericarditis, drug toxicity can happen in this time period.

Late postoperative complications (>12 months): posttransplant lymphoproliferative disease, cardiac allograft vasculopathy, infection, kaposi sarcoma and other malignancies, aortic dissection, pseudoaneurysm formation, and thromboembolism.
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Conclusions: As the use of OHT for end-stage heart disease continues, familiarity with expected and unexpected procedure and treatment-related imaging findings is needed. Because clinical manifestations of disease may be delayed in OHT recipients, radiologists can be the first one in the health care team to recognize early postoperative complications.