Long-term hemodynamic evaluation after heart transplantation has rarely been reported. Fifty-seven heart transplant recipients (mean age, 42.1 years: range, 22 to 56 years) were investigated with annual cardiac catheterization. Mean follow-up was 2.2 years (range, 1 to 7 years). Years 1 through 5 were evaluated statistically. Hemodynamic variables did not change significantly during the 5-year period. Mean aortic pressure (105 +/- 16 to 115 +/- 17 mm Hg, minimum and maximum annual average value +/- SD of the 5-year period) and LVEDP (13 +/- 6 to 15 +/- 7 mm Hg) were slightly elevated. Borderline values were found for mean pulmonary artery pressure (18 +/- 4 to 21 +/- 5 mm Hg), systemic vascular resistance (1407 +/- 227 to 1487 +/- 409 dynes.sec.cm-5), pulmonary vascular resistance (86 +/- 42 to 118 +/- 66 dynes.sec.cm-5), and heart rate (85 +/- 17 to 95 +/- 14 beats/min). Mean right atrial pressure (5 +/- 2 to 8 +/- 4 mm Hg), cardiac index (2.8 +/- 0.6 to 3.5 +/- 1.1 L/min/m2), end-diastolic volume (111 +/- 37 to 137 +/- 35 ml) and ejection fraction (69% +/- 10% to 75% +/- 9%) were in the normal range. Pressure-volume loops for each year excluded the development of either restrictive or dilated cardiomyopathy with time. Contractility, as measured by imposing afterload stress, was normal in 12 of 14 representative patients. Prevalence of coronary abnormalities (circumscript coronary stenoses, diffuse vessel obliteration or dilated angiopathy) increased from 14.9% in the first to 66.7% in the fifth year. Of the patients, 93% received antihypertensive drugs.(ABSTRACT TRUNCATED AT 250 WORDS)