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Related Experiment Videos

Coronary collateral circulation in the transplanted heart

S Bajaj1, A Shah, C Crandall

  • 1McGuire Veterans Administration Medical Center, Richmond, Va.

Circulation
|November 1, 1993
PubMed
Summary

Cardiac transplant recipients may develop atypical coronary collateral circulation, characterized by a "blush pattern." This suggests an angiogenic response to microvascular ischemia in allograft coronary arteriopathy.

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Area of Science:

  • Cardiology
  • Transplant Medicine
  • Vascular Biology

Background:

  • The development of coronary collateral (CC) circulation in cardiac transplant recipients (CTR) is debated, with prior studies suggesting reduced CC occurrence.
  • Previous research indicates a lower incidence of CC in CTR compared to non-transplanted individuals.

Purpose of the Study:

  • To investigate the presence and significance of CC in denervated human hearts of CTR.
  • To compare CC development in CTR with that in non-transplanted patients.

Main Methods:

  • A review of 102 coronary angiograms from 73 CTR and 70 non-transplanted patients.
  • Analysis of CC using a modified Rentrop classification (grade 0-4).
  • Classification of coronary artery disease as large vessel disease (LVD) or small vessel (epicardial) disease (SVD).

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Main Results:

  • While mature collaterals (grade 4) were more frequent in non-transplanted hearts with LVD, CTR showed a higher prevalence of grade 2 and 3 CC with a "myocardial blush" pattern.
  • This blush pattern in CTR was predominantly associated with small vessel coronary arteriopathy.
  • Overall CC presence varied, with grade 1 being most common in CTR (56%) and grade 0 in controls (67%).

Conclusions:

  • The findings suggest the presence of atypical CC in CTR with cardiac allograft arteriopathy.
  • The observed "blush pattern" may indicate an angiogenic response to microvascular ischemia.
  • This atypical CC formation warrants further investigation in the context of allograft vasculopathy.