Boffa G M, Livi U, Grassi G, Casarotto D, Isabella G, Cardaioli P, Panfili M, Chioin R
Department of Cardiology, University of Padua Medical School, Padua, Italy.
Int J Cardiol. 2000 Mar 31;73(1):67-74. doi: 10.1016/s0167-5273(99)00225-9.
We describe the angiographic characteristics of coronary artery spasm observed in 12 out of 247 (4.9%) patients who underwent 808 coronary angiographies after heart transplantation. Coronary artery spasm was diagnosed when localized and reversible narrowing of the coronary lumen was identified. After coronary artery spasm identification all patients were followed-up clinically for a mean period of 5.1 years. Coronary artery spasm was documented 1-3 years after heart transplant. Coronary artery spasm affected 1 main coronary artery in 10 patients and 2 in 2 patients; in 3 patients 1 or more secondary branches were also affected. The right coronary artery was affected by coronary artery spasm in 8 patients and the anterior descending coronary artery in 6 patients. In 6 patients coronary artery spasm was mechanically induced by the catheter tip. The degree of luminal narrowing due to coronary artery spasm ranged from mild to almost complete occlusion. Coronary artery spasm appeared as a single tubular smooth and concentric stenosis in 8 patients, was discrete in 2 patients and multiple on the same vessel in 2 patients. In 1 patient coronary artery spasm was erroneously interpreted as an organic lesion and percutaneous transluminal coronary angioplasty was planned. During follow-up 3 patients out of 4 who had shown multiple coronary artery spasm died and 2 patients developed critical organic stenosis. In conclusion coronary artery spasm after heart transplant is less rare than commonly believed. Although it usually has a peculiar appearance, it can be misinterpreted as an organic lesion. Multiple coronary artery spasm appears to carry a poor prognosis.
我们描述了在247例接受心脏移植后进行808次冠状动脉造影的患者中，247例中的12例（4.9%）观察到的冠状动脉痉挛的血管造影特征。当发现冠状动脉腔局限性且可逆性狭窄时，即可诊断为冠状动脉痉挛。在确认冠状动脉痉挛后，所有患者均接受了平均5.1年的临床随访。冠状动脉痉挛记录于心脏移植后1至3年。冠状动脉痉挛累及10例患者的1支主要冠状动脉和2例患者的2支主要冠状动脉；3例患者的1支或更多支二级分支也受到影响。8例患者的右冠状动脉受到冠状动脉痉挛影响，6例患者的前降支冠状动脉受到影响。6例患者的冠状动脉痉挛是由导管尖端机械诱发的。冠状动脉痉挛导致的管腔狭窄程度从轻度到几乎完全闭塞不等。8例患者的冠状动脉痉挛表现为单一的管状、光滑且同心的狭窄，2例患者的狭窄是离散的，2例患者在同一血管上有多处狭窄。1例患者的冠状动脉痉挛被错误地解释为器质性病变，并计划进行经皮腔内冠状动脉成形术。在随访期间，4例出现多处冠状动脉痉挛的患者中有3例死亡，2例患者出现严重的器质性狭窄。总之，心脏移植后的冠状动脉痉挛并不像通常认为的那样罕见。虽然它通常有独特的表现，但可能被误诊为器质性病变。多处冠状动脉痉挛似乎预后不良。
