Related Experiment Videos
Coronary artery bypass two years after orthotopic heart transplantation: a case report
O H Frazier1, J D Vega, J M Duncan
1Section of Transplantation, Texas Heart Institute, Houston 77025-0345.
Insights
A 58-year-old heart transplant recipient with severe coronary artery disease underwent successful aortocoronary bypass surgery. This procedure improved ejection fraction, offering an alternative to re-transplantation for cardiac allograft atherosclerosis.
Area of Science:
- Cardiology
- Transplantation Immunology
- Vascular Surgery
Background:
- Cardiac allograft atherosclerosis is a significant long-term complication following heart transplantation.
- Limited donor heart availability necessitates alternative treatment strategies for failing allografts.
Observation:
- A 58-year-old male heart transplant recipient developed complete occlusion of the left anterior descending and right coronary arteries two years post-transplant.
- The patient presented with progressive dyspnea, reversible myocardial ischemia, and declining ejection fraction.
Findings:
- Aortocoronary bypass grafting was successfully performed, with no intraoperative complications.
- Postoperative ejection fraction improved by over 58%, indicating successful restoration of cardiac function.
Implications:
- Aortocoronary bypass grafting presents a viable alternative treatment for cardiac allograft atherosclerosis, potentially preserving allograft function.
- This approach offers a crucial alternative to repeat transplantation in managing coronary artery disease in heart allografts.
- Further research into surgical interventions for allograft vasculopathy is warranted given the donor organ shortage.
Abstract:
Complete occlusion of the left anterior descending and right coronary arteries developed in a 58-year-old man 2 years after orthotopic heart transplantation. Because of his progressive shortness of breath, reversible myocardial ischemia, and decreasing ejection fraction, aortocoronary bypass was recommended. The operation was performed without complications, and his postoperative ejection fraction improved by more than 58%. In the past, when coronary artery disease developed in cardiac allografts, another transplant procedure was the only treatment option. Because of the limited donor hearts available today, new strategies are necessary for the treatment of cardiac allograft atherosclerosis.