Frantz R P, Lerman A, Edwards B S, Olson L J, Higano S T, Schwartz R S, Daly R C, McGregor C G, Rodeheffer R J
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905.
J Heart Lung Transplant. 1994 Sep-Oct;13(5):834-9.
Coronary artery spasm is a rarely reported condition after heart transplantation. We report a case of exercise-induced coronary artery spasm in a patient 1-year after orthotopic heart transplantation. Serial quantitative coronary angiography showed significant diffuse loss of luminal diameter. Provocative testing with intracoronary acetylcholine and intravenous methylergonovine maleate was performed in an effort to document efficacy of the antispasm regimen. Infusion of acetylcholine into the left anterior descending coronary artery resulted in transient closure of the vessel. Diffuse spasm resulting in hypotension and ventricular fibrillation occurred with intravenous methylergonovine maleate administration. Because of the risk of provoking diffuse spasm, intravenous administration of methylergonovine maleate should be avoided in the posttransplantation setting. Review of the literature suggests that coronary artery spasm after transplantation is often associated with severe transplant coronary artery disease and may be associated with a poor prognosis. Coronary artery spasm may be a more common cause of syncope and death after transplantation than it is currently thought to be.
冠状动脉痉挛是心脏移植术后一种鲜有报道的病症。我们报告一例原位心脏移植术后1年患者出现运动诱发的冠状动脉痉挛的病例。系列定量冠状动脉造影显示管腔直径显著弥漫性减小。为证明抗痉挛治疗方案的疗效，进行了冠状动脉内乙酰胆碱和静脉注射马来酸麦角新碱激发试验。向左前降支冠状动脉内注入乙酰胆碱导致血管短暂闭塞。静脉注射马来酸麦角新碱时出现弥漫性痉挛，导致低血压和心室颤动。由于有引发弥漫性痉挛的风险，在移植后应避免静脉注射马来酸麦角新碱。文献回顾表明，移植后冠状动脉痉挛常与严重的移植冠状动脉疾病相关，且可能与预后不良有关。冠状动脉痉挛可能是移植后晕厥和死亡比目前认为的更常见的原因。
