Mullins P A, Cary N R, Sharples L, Scott J, Aravot D, Large S R, Wallwork J, Schofield P M
Transplant Unit, Papworth Hospital, Huntingdon, Cambridge.
Br Heart J. 1992 Sep;68(3):260-5. doi: 10.1136/hrt.68.9.260.
Coronary occlusive disease is the main cause of late mortality after cardiac transplantation. It has both similarities and differences compared with conventional atherosclerotic coronary disease. The pathophysiology of late graft failure from coronary occlusive disease is unclear at present. We reviewed the experience of this disorder in our cardiac transplant programme.
A retrospective analysis of angiographic and pathological data.
A regional cardiothoracic centre and transplant unit.
Of a population of 383 orthotopic cardiac transplant recipients operated upon between January 1979 and June 1990, 447 coronary angiograms were available for review in 193 patients. Thirteen of a possible 18 results of post mortem examinations from patients dying from coronary occlusive disease were available.
Coronary occlusive disease was defined as any evidence of disease on coronary angiography. Post mortem examinations were performed with standard techniques.
The angiographic prevalence of coronary occlusive disease was 3% (1/32 patients) and 40% (19/47 patients) at one and five years respectively. Twenty six grafts failed due to coronary occlusive disease compared with 132 graft failures from all causes during this period. Acute thrombosis was present in a large vessel in seven of 13 fatal cases undergoing necropsy (54%). Noticeable large vessel involvement with disease in smaller distal vessels was present in four patients (31%). The remaining two patients (15%) had small vessel disease alone. Twelve of the 13 patients had significant cardiomegaly (cardiac weight > or = 400 g) with a mean weight of 510 (range 370-740) g.
Coronary occlusive disease is the main late complication after cardiac transplantation. A combination of coronary thrombosis, ischaemia from stenoses of large and small coronary vessels, and cardiomegaly contribute to the graft failure of these patients.
冠状动脉闭塞性疾病是心脏移植术后晚期死亡的主要原因。它与传统的动脉粥样硬化性冠状动脉疾病既有相似之处，又有不同之处。目前，冠状动脉闭塞性疾病导致晚期移植物功能衰竭的病理生理学尚不清楚。我们回顾了我们心脏移植项目中对这种疾病的治疗经验。
对血管造影和病理数据进行回顾性分析。
一个地区性心胸中心和移植单位。
在1979年1月至1990年6月期间接受原位心脏移植的383名患者中，193名患者的447份冠状动脉造影可供回顾。在因冠状动脉闭塞性疾病死亡的患者中，18份尸检结果中有13份可供使用。
冠状动脉闭塞性疾病定义为冠状动脉造影上任何疾病证据。尸检采用标准技术。
冠状动脉闭塞性疾病的血管造影患病率在1年和5年时分别为3%（1/32例患者）和40%（19/47例患者）。在此期间，26例移植物因冠状动脉闭塞性疾病失败，而所有原因导致的移植物失败为132例。13例进行尸检的致命病例中有7例（54%）在大血管中存在急性血栓形成。4例患者（31%）在较小的远端血管中有明显的大血管受累伴疾病。其余2例患者（15%）仅有小血管疾病。13例患者中有12例有明显的心脏增大（心脏重量≥400 g），平均重量为510（范围370 - 740）g。
冠状动脉闭塞性疾病是心脏移植术后主要的晚期并发症。冠状动脉血栓形成、大、小冠状动脉狭窄导致的缺血以及心脏增大共同导致了这些患者的移植物功能衰竭。
