Heart Transplantation: Main Anatomical Alterations

Abstract

Heart transplantation is the most effective treatment for well-selected patients with end-stage heart failure, it offers great challenges though. That procedure can be used to exemplify the adaptive capacity of the heart and the integration of the cardiovascular system components after multiple injuries such as ischemia, rejection, pulmonary hypertension, infection, immunosuppression, and so on. New researches about metabolic, molecular and structural remodeling during the development of heart failure due to the brain death consequences on the heart donor and after the transplantation surgical procedure will lead to a better understanding of the heart adaptive capacity which may modify clinical treatment. The inflammatory response and reperfusion injury associated with cardiopulmonary bypass, cardioplegic arrest and immunological factors are key triggers of myocardial injury during heart transplantation. The normal right ventricle has different vulnerability to cardiac insults compared to the left cavity. This occurs due to elevated pulmonary pressure of the recipient and represents the major cause of early allograft dysfunction. This review was addressed to describe some key issues related to anatomical alterations that heart suffers with cardiac failure development with the attempt to react to the systemic responses and also, to the depression of myocardial function observed with dead brain and after the transplantation procedure.