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Updated: Jan 1, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Case report - coronary vasospasm in transplanted heart: a puzzling phenomenon
M Pagnoni1,2, J Regamey3, J Adjedj3
1Service de chirurgie cardiaque, Département cœur-vaisseaux, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011, Lausanne, Switzerland. Mattia.pagnoni@chuv.ch.
Insights
Coronary artery spasm (CAS) can occur in heart transplant recipients, even after surgery. This case highlights potential early relapse due to donor heart dysfunction and recipient factors.
Area of Science:
- Cardiology
- Transplantation Medicine
- Vascular Biology
Background:
- Coronary artery spasm (CAS) is underdiagnosed in heart transplant patients.
- Etiology and pathophysiology of CAS in this population are largely unknown.
- CAS is associated with cardiac allograft vasculopathy and graft rejection.
Observation:
- A heart transplant recipient experienced two episodes of coronary artery spasm.
- The first spasm occurred before transplantation.
- The second spasm occurred one month post-transplant, during a period of primary graft failure.
Findings:
- A transplanted heart with a predisposition to coronary vasospasm can experience early relapse.
- Autonomic denervation does not prevent post-transplant coronary vasospasm.
- Exacerbated donor heart endothelial dysfunction and recipient systemic factors may contribute.
Implications:
- This case underscores the importance of considering CAS in heart transplant recipients.
- Further research is needed to elucidate the mechanisms of post-transplant CAS.
- Understanding these mechanisms may improve management and outcomes for heart transplant patients.
Background:
Coronary artery spasm (CAS) is an underdiagnosed disease especially in heart transplant patients, and in those patients the etiology and pathophysiology remain largely unknown, although it has been associated with cardiac allograft vasculopathy or graft rejection.
Case Presentation:
We report the case of a heart-transplant patient whose cardiac graft experienced two coronary vasospasms: the first before transplantation, and the other at one-month of a postoperative course complicated by primary graft failure.
Conclusion:
Our case illustrates that a transplanted heart predisposed with coronary vasospasm may suffer from early relapse in the recipient despite of complete post-surgical autonomic denervation. Exacerbated endothelial dysfunction of the donor heart after transplant, with the addition of systemic factors in the recipient may be involved in the genesis of this puzzling phenomenon.
