UMEM Educational Pearls

Title: Childhood Heart Transplantation

Keywords: Heart Transplantation, Rejection, Syncope, Chest Pain (PubMed Search)

Posted: 11/2/2007 by Sean Fox, MD (Updated: 4/25/2024)
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Children s/p Heart Transplantation – Rejection

Children need heart transplantation for complex congenital heart defects (hypoplastic left heart syndrome is most common) or dilated cardiomyopathies.

Signs of Acute rejection
- Chest Pain is uncommon
- Common presentions: fever, myalgias, and vomiting.
  - ECG may show a decreased R wave amplitude and an increased QRS duration.
- Labs are most often NOT diagnostic in acute rejection.
  - Troponin and CK levels may or may not be elevated.
  - Elevated LFTs are concerning for right heart failure.
- Echo – Diastolic dysfunction is the earliest change seen in acute rejection
Signs of Chronic Rejection
- Clinical symptoms often related to the accelerated atherosclerosis
- “Silent” ischemia or infarction – decreased exercise tolerance or malaise
- Syncope

Woods, WA. Care of the Acutely Ill Pediatric Heart Transplant Recipient. Pediatric Emergency Care. 23(10):721-724, October 2007.