Alam Mohammed Shakawat, Singh Arvind Sahadev, Pavithran Sreeja, Subban Vijayakumar, Mullasari Ajit, Sivakumar Kothandam
Department of Cardiology, Madras Medical Mission, Chennai, Tamil Nadu, India.
Ann Pediatr Cardiol. 2020 Jul-Sep;13(3):234-237. doi: 10.4103/apc.APC_69_19. Epub 2020 Jun 2.
Coronary allograft vasculopathy fails to give a warning anginal pain due to denervation and often presents with acute coronary syndrome, ventricular dysfunction, or sudden cardiac death. Early diagnosis in a pediatric patient is difficult as it involves invasive coronary angiography or advanced imaging such as intravascular ultrasound or optical coherence tomography. A 12-year-old boy developed acute coronary syndrome, elevated troponins, and right bundle branch block, 5 years after cardiac transplantation and was treated with culprit-vessel angioplasty with a drug-eluting stent. Advanced imaging showed the involvement of nonculprit vessels too. In a detailed literature search, we failed to identify a similar clinical presentation and management in the subcontinent, hence our interest in publishing this report for educational value. Issues in diagnosis, management, prognosis, and prevention are discussed.
由于去神经支配，心脏移植术后冠状动脉血管病变不会引发警示性心绞痛，常表现为急性冠状动脉综合征、心室功能障碍或心源性猝死。儿科患者早期诊断困难，因为这需要进行有创冠状动脉造影或先进成像检查，如血管内超声或光学相干断层扫描。一名12岁男孩在心脏移植术后5年出现急性冠状动脉综合征、肌钙蛋白升高及右束支传导阻滞，接受了药物洗脱支架的罪犯血管血管成形术治疗。先进成像显示非罪犯血管也受累。在详细的文献检索中，我们未能在该次大陆地区找到类似的临床表现及治疗方法，因此我们有兴趣发表本报告以提供教育价值。文中讨论了诊断、治疗、预后及预防方面的问题。
