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Heart transplant coronary artery disease: Multimodality approach in percutaneous intervention

Luís Leite1, Vítor Matos1, Lino Gonçalves1

  • 1Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology
|June 1, 2016
PubMed

Insights

Coronary artery disease after heart transplant is a major concern. This case study highlights using advanced imaging and functional tests to effectively manage cardiac allograft vasculopathy.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Immunology

Background:

  • Coronary artery disease (CAD) is a leading cause of death after heart transplantation, often due to cardiac allograft vasculopathy (CAV) or donor-transmitted atherosclerosis.
  • Standard surveillance via coronary angiography may not fully characterize lesion severity or guide intervention.
  • Optimizing treatment requires a comprehensive approach beyond traditional angiography.

Observation:

  • A five-year post-heart transplant follow-up case is presented.
  • Coronary angiography revealed significant lesions.
  • Intracoronary imaging and functional assessment were employed to evaluate the coronary lesions.

Findings:

  • Optical coherence tomography (OCT) provided detailed morphological information about the coronary lesions.
  • Fractional flow reserve (FFR) assessed the functional significance of these lesions.
  • Combined OCT and FFR guided the optimization of percutaneous coronary intervention (PCI).

Implications:

  • Intracoronary imaging and functional assessment are crucial complements to coronary angiography in heart transplant recipients.
  • This integrated approach aids in accurate diagnosis and tailored treatment strategies for post-transplant coronary artery disease.
  • Optimized management can improve outcomes and reduce morbidity and mortality in this vulnerable patient population.

Keywords:
Cardiac allograft vasculopathyCoronary artery diseaseDoença coronáriaFractional flow reserveHeart transplantationIntervenção coronária percutâneaOptical coherence tomographyPercutaneous coronary interventionTomografia de coerência óticaTransplante cardíacoVasculopatia do enxerto

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