Abstract
Coronary artery vasospasm (CVS) has been described in orthotopic heart transplant
patients but is rare in the post-transplanted, denervated heart. Severe CVS has been
associated with accelerated cardiac allograft vasculopathy (CAV) and allograft rejection.
Allograft vasculopathy is the leading cause of decreased long-term survival in orthotopic
heart transplant. The prognostic significance and relationship of the presence and
severity of CVS with CAV are not well understood. We present a case of severe symptomatic
CVS with rapid development of severe CAV. Our case emphasizes the need for close angiographic
surveillance and intracoronary imaging for early detection of CAV in the presence
of vasospasm.
Résumé
L’angiospasme coronarien a été décrit chez des patients ayant subi une transplantation
cardiaque orthotopique, mais est rare dans le cœur dénervé post-transplantation. L’angiospasme
coronarien grave a été associé à une vasculopathie de l’allogreffe cardiaque (VAC)
accélérée et au rejet de l’allogreffe. La vasculopathie de l'allogreffe est la première
cause de la survie à long terme réduite chez les patients ayant subi une transplantation
cardiaque orthotopique. L’importance pronostique et le lien entre la présence et la
gravité de l’angiospasme coronarien et la VAC ne sont pas bien compris. Nous présentons
un cas d'angiospasme coronarien symptomatique grave accompagné de l’apparition rapide
d’une VAC grave. Ce cas souligne l’importance d’une surveillance angiographique étroite
et de l’imagerie intracoronarienne pour le dépistage précoce de la VAC en présence
d’un angiospasme.
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References
- Coronary artery spasm after cardiac transplantation.Am J Cardiol. 1990; 65: 1515-1518
- Cardiac allograft vasculopathy: a review.Can J Surg. 2005; 48: 319-327
- Coronary vasospasm: a silent enemy in orthotopic heart transplant.Coron Artery Dis. 2018; 29: 86-87
- Catheter-induced versus spontaneous spasm: do these coronary bedfellows deserve to be estranged?.Am J Med. 1985; 79: 1-4
- Conversion to sirolimus as primary immunosuppression attenuates the progression of allograft vasculopathy after cardiac transplantation.Circulation. 2007; 116: 2726-2733
Article info
Publication history
Published online: August 20, 2018
Accepted:
August 14,
2018
Received:
July 18,
2018
Footnotes
See page 1687.e11 for disclosure information.
Identification
Copyright
© 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
