ABSTRACT
Immediately following orthotopic transplantation, a patient suffered left pump failure, which resulted in death. Autopsy of the donor heart revealed a proximal left anterior descending artery bridge with a thrombus causing segmental distal anteroseptal infarction. In this case report, myocardial coronary bridges and their clinical implications are reviewed. Myocardial bridging and acute coronary obstruction should be considered in the differential diagnosis of patients with acute pump dysfunction following orthotopic cardiac transplantation.
Subject(s)
Coronary Thrombosis/complications , Coronary Vessel Anomalies/complications , Heart Transplantation , Myocardial Infarction/etiology , Postoperative Complications , Fatal Outcome , Humans , Male , Middle Aged , Myocardial Ischemia/surgeryABSTRACT
BACKGROUND AND HYPOTHESIS: Initial studies have shown holmium laser to be effective in ablation of coronary atheroma, and small studies that it may be helpful in ablation of thrombotic stenoses. Therefore, holmium laser-assisted coronary angioplasty was studied in 85 consecutive patients with acute ischemia syndromes. METHODS: Indications for therapy were acute myocardial infarction (MI) in 7 patients (8%), post-MI ischemic in 32 patients (38%), and crescendo angina pectoris in 46 patients (54%). Coronary morphology characteristics by multivessel angioplasty prognosis group criteria were Type A in 9 (10%), Type B1 in 15 (18%), Type B2 in 44 (52%), Type C in 17 patients (20%). RESULTS: Angiographic evidence of thrombus was seen in 37 (44%) of patients. The laser successfully crossed the total length of the coronary narrowing in 76 patients (89%). Procedure/clinical success was 92% for the total study population, 100% for patients with acute MI, 94% for post-MI ischemia patients, and 89% for patients with crescendo angina. Lesions with and without thrombus had identical procedure success rates. Major complication rate was 3.5%, (deaths 0%, Q-wave MI 0%, and emergent bypass surgery 3.5%). Six-month angiographic restenosis rate (> 50% stenosis) was 45%. CONCLUSION: Holmium laser-assisted balloon angioplasty appears promising in the treatment of acute ischemic syndromes and thrombotic coronary lesions.