Coronary arterial disease in one long-term survivor receiving heart transplantation / 中华器官移植杂志

ABSTRACT

Objective To study the possible cause and the feasibility of diagnosis and treatment of coronary disease after heart transplantation.Methods An 8-year survivor of heart transplantation received close follow-up. The clinical symptoms were recorded. Blood laboratory tests, electrocardiogram, endomyocardial biopsy, left ventricular Tc scintigraphy, endothelium-dependent vasodilatation of the brachial artery and coronary angiography were performed.Results The patient had good life quality without any symptoms such as chest discomfort, palpitation, dyspnea. Serum lipid and lipoprotein levels remained normal range. No any myocardial ischemic signs were detected in electrocardiogram. Endothelium-dependent vasodilatation was normal. No any acute rejective manifestation was observed in endomyocardial biopsy samples. Left ventricular Tc scintigraphy showed that left ventricular wall perfusion was progressively decreased. Coronary angiography showed that a typical vasculopathy with diffuse stenosis involved all coronary braches to some extent and right coronary had a proximal local severe stenosis with distal mild diffuse stenosis. Coronary angioplasty and stent placement of proximal right coronary was performed. The perfusion of the left ventricular wall was improved by this angioplasty.Conclusion Chronic rejection is probably the main cause of coronary disease after heart transplantation. Serial left ventricular scintigraphy can detect the change of myocardial perfusion. Local severe stenosis of coronary after heart transplantation can be treated by coronary stenting.