Coma-Canella I, Maceira A, Díaz Dorronsoro I, Calabuig J, Martínez A
Departamento de Cardiología y Cirugía Cardiovascular, Facultad de Medicina, Universidad de Navarra, Pamplona.
Rev Esp Cardiol. 1999 Jul;52(7):485-92. doi: 10.1016/s0300-8932(99)74956-0.
Diffuse or focal coronary artery narrowing is a frequent complication of cardiac transplantation. Coronary enlargement has also been described although it is less known. To study the changes of the coronary arteries in transplant recipients, we have performed a quantitative study throughout 5 years.
Serial coronary angiography was performed annually in all survivors of heart transplant. Forty four patients with visually normal coronary arteries and at least 5 years of evolution were selected for this study. Quantitative measurements of the diameter of the coronary arteries were performed in each angiogram at different levels: proximal, medium and distal left anterior descending coronary artery; proximal and distal left circumflex; proximal, medium and distal right coronary artery. Changes in diameter were compared throughout the 5 years.
In the entire group of patients there was a small increase in the diameter of each segment. Taking each patient separately, an enlargement of the diameter of the proximal descending coronary artery was seen in 17 cases; medium descending coronary artery in 13; distal descending coronary artery in 8; proximal left circumflex in 11; distal left circumflex in 14; proximal right coronary artery in 18; medium right coronary artery in 18 and distal right coronary artery in 15. In total, 114 of 352 coronary segments (32%) underwent dilatation. Only 6 patients failed to have dilatation of any segment.
Enlargement of the coronary arterial diameter was seen in 32% of segments of the main coronary arteries in heart transplant recipients with angiographically normal coronary arteries during 5 years of evolution. This could be due to intimal thickening with overcompensation by an additional vessel enlargement with net lumen gain.
弥漫性或局灶性冠状动脉狭窄是心脏移植常见的并发症。冠状动脉扩张也有相关报道，尽管了解较少。为研究心脏移植受者冠状动脉的变化，我们进行了为期5年的定量研究。
对所有心脏移植存活者每年进行系列冠状动脉造影。本研究选取了44例冠状动脉造影显示正常且病程至少5年的患者。在每张血管造影图像上，对不同节段的冠状动脉直径进行定量测量：左前降支冠状动脉近端、中段和远端；左旋支近端和远端；右冠状动脉近端、中段和远端。比较5年间各节段直径的变化。
在整个患者组中，每个节段的直径均有小幅增加。单独分析每个患者，17例患者的左前降支冠状动脉近端直径增大；13例中段左前降支冠状动脉直径增大；8例远端左前降支冠状动脉直径增大；11例左旋支近端直径增大；14例左旋支远端直径增大；18例右冠状动脉近端直径增大；18例右冠状动脉中段直径增大；15例右冠状动脉远端直径增大。总共352个冠状动脉节段中有114个（32%）发生扩张。只有6例患者没有任何节段的扩张。
在冠状动脉造影正常的心脏移植受者中，5年病程期间，32%的主要冠状动脉节段出现冠状动脉直径增大。这可能是由于内膜增厚，额外的血管扩张过度补偿，导致净管腔增加。
