Peter Lesný, Eva Goncalvesová, Milan Luknár, Ivana Štefanková, Juraj Fabián
The activity of the transplanted heart differs from that at physiologic circumstances. At heart transplantation (HTx), the original dysfunctional heart is replaced by a heart with a good mechanical function which results in a dramatic change of hemodynamic situation after HTx. Cardiac output is increased and pulmonary pressures fall. Typical morphological changes after HTx include right ventricular and left ventricular dilation, hypertrophy of the intervetricular septum and free wall of the left ventricle, and mild tricuspid regurgitation. Post-transplant circulation is to a great extent influenced by autonomic denervation of the heart. Denervation results in an increased resting heart rate, chronotropic incompetence, impairment of the diurnal variation of the blood pressure, and asymptomatic myocardial ischemia. Re-inervation after HTx is possible with a great interindividual variability. The peripheral circulation after HTx is characteristic by a decreased peripheral flow, increased peripheral vascular resistance, and decreased venous compliance. The circulation after HTx has several characteristic features. If no factors with a negative influence on implanted myocardium are present (rejection, ischemia), the circulation remains stable in the long term. More than 90 % patients after HTx are in a good clinical shape, they are able of daily living activities and desired physical exercise necessary for good quality life.