Related Experiment Video
Updated: Mar 10, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
ST Elevation Infarction after Heart Transplantation Induced by Coronary Spasms and Mural Thrombus Detected by Optical
Tor Skibsted Clemmensen1, Niels Ramsing Holm1, Hans Eiskjær1
1Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Insights
Coronary spasms after heart transplant (HTx) may link to thrombus formation. Optical coherence tomography (OCT) revealed significant thrombi in a heart transplant patient, highlighting OCT
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Imaging
Background:
- Coronary artery spasms and sudden death are common, yet poorly understood, complications following heart transplantation (HTx).
- Acute myocardial infarction in HTx patients can be triggered by severe coronary spasms.
Purpose of the Study:
- To illustrate a potential link between coronary spasms, thrombus formation, and outcomes in heart transplant recipients.
- To highlight the diagnostic utility of optical coherence tomography (OCT) in managing HTx patients with suspected coronary artery disease.
Main Methods:
- Case report of a 19-year-old heart transplant patient presenting with acute myocardial infarction.
- Utilized optical coherence tomography (OCT) for high-resolution imaging of coronary arteries.
- Managed the patient with percutaneous coronary intervention.
Main Results:
- OCT imaging revealed extensive, organized thrombi in the left main, circumflex, and left anterior descending coronary arteries.
- The patient's condition stabilized following percutaneous coronary intervention.
- Coronary angiography may not detect mural thrombi effectively.
Conclusions:
- This case suggests a possible association between coronary spasms and intraluminal thrombus formation in heart transplant patients.
- Optical coherence tomography (OCT) offers valuable high-resolution imaging for diagnosing coronary artery issues in HTx patients.
- OCT may be crucial for identifying mural thrombi, which can be missed by conventional angiography, in HTx patients experiencing myocardial infarction or coronary spasms.
Abstract:
The case illustrates the possible link between coronary spasms, intraluminal thrombus formation, and widespread organized and layered thrombi in HTx patients. Furthermore, the case underlines the clinical value of OCT as a novel method for high-resolution vessel imaging in heart-transplanted (HTx) patients with coronary spasms and suspected coronary artery disease. Coronary spasms and sudden death are frequent complications after HTx. The underlying mechanisms leading to these complications are unknown. The present case displays the clinical course of a 19-year-old HTx patient who was hospitalized due to acute myocardial infarction induced by severe coronary spasms. The patients remained unstable on conservative therapy. Therefore, an optical coherence tomography (OCT) was performed and revealed massive, organized thrombi in the left main coronary artery, the circumflex coronary artery, and the left anterior descending coronary artery. The patient was stabilized after percutaneous coronary intervention. As a mural thrombus often goes undetected by coronary angiography, OCT may prove benefit in HTx patients with myocardial infarction or suspected coronary spasms.
