Ballester M, Obrador D, Carrió I, Bordes R, Augé J M, Crexells C, Oriol A, Padró J M, Arís A, Caralps J M
Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
J Heart Transplant. 1989 Sep-Oct;8(5):413-7.
Four patients who underwent heart transplantation, in whom coronary obstruction was seen early after transplantation, are described. Repeated acute rejection episodes were detected within the first 2 months in each patient. Coronary obstruction or ischemia was shown through a combination of T1-201 isotopic study findings, evidence of vasculitis of a small coronary arteriole seen at endomyocardial biopsy, or coronary angiographic results. Vigorous treatment for rejection (antithymocyte globulin and bolus methylprednisolone) was given, and coronary artery lesions or myocardial ischemia resolved after treatment. Rejection-induced coronary obstruction should be considered in patients with repeated acute rejection episodes who are predisposed to the development of vascular rejection. Early after transplantation such obstruction is caused by diffuse vasculitis of small and medium-sized vessels and may be reversed with increased immunosuppression.
本文描述了4例心脏移植患者，这些患者在移植后早期出现冠状动脉阻塞。每名患者在术后头2个月内均检测到反复发生的急性排斥反应。通过锝-201同位素研究结果、心内膜心肌活检显示的小冠状动脉血管炎证据或冠状动脉造影结果，证实存在冠状动脉阻塞或缺血。对排斥反应进行了积极治疗（抗胸腺细胞球蛋白和大剂量甲基强的松龙），治疗后冠状动脉病变或心肌缺血得到缓解。对于有反复急性排斥反应且易发生血管性排斥反应的患者，应考虑排斥反应诱导的冠状动脉阻塞。移植后早期，这种阻塞是由中小血管的弥漫性血管炎引起的，增加免疫抑制可能使其逆转。
