ABC | Volume 113, Nº1, July 2019

Statement Position Statement on Indications of Echocardiography in Adults – 2019 Arq Bras Cardiol. 2019; 113(1):135-181 Figure 1 – Echocardiographic evaluation after cardiac transplantation. *Graft dysfunction: confirmed on echocardiographic examination by dropping the ejection fraction by more than 10% to a value lower than 50%, compared to the baseline examination of the sixth month; § patients with graft dysfunction suspected or confirmed; clinical symptoms of a possible new cardiac abnormality; alterations in the resting electrocardiogram. Consider additional echocardiographic studies to monitor episodes of acute graft rejection or dysfunction Consider a dobutamine stress echocardiography for the evaluation of graft vascular diseases if: - suitable acoustic window - chronic kidney disease - medical center with adequate experience in the methodology Note: if possible, associate with evaluation of the coronary reserve flow or myocardial perfusion. Immediate postoperative evaluation: - focused echocardiographic study to identify surgical complications and acute graft dysfunction* (consider serial assessments during hospitalization, if necessary) Pre-hospital discharge: - comprehensive echocardiographic examination to evaluate graft function Consider echocardiographic studies during outpatient follow-up of the first six months: - complement the endomyocardial biopsies - monitor acute rejection - monitor graft function Sixth month of follow-up: - comprehensive baseline echocardiographic study as a reference for future comparisons Between the sixth and twelfth month of follow-up: - echocardiographic examination after each endomyocardial biopsy - additional echocardiographic exams if clinically indicated (at least one echocardiography every three months) During the second year of follow-up: - echocardiographic examination after each endomyocardial biopsy - additional echocardiographic exams if clinically indicated (at least one echocardiography every six months) After the second year of follow up: - echocardiographic examination after each endomyocardial biopsy - additional echocardiographic exams if clinically indicated § cardiotoxic chemotherapeutics. If it is not possible in all patients, it is recommended in those at high risk for the development of CT: age > 65 years, previous left ventricular dysfunction, predicted use of high doses of anthracyclines (type I) or combination of type I and II drugs. To perform the LVEF assessment by the 3D TTE if available or, alternatively, 144