Applications of percutaneous transluminal coronary angioplasty in cardiac transplantation. Preliminary results in five patients.
Atherosclerotic coronary artery disease is the major cause of late cardiac transplant failure secondary to silent ischemia and infarction. To increase the longevity of cardiac homografts, we performed percutaneous transluminal coronary angioplasty (PTCA) in five male patients (aged 45 +/- 7 years, mean +/- SEM); 17 lesions were dilated during eight procedures 83 +/- 11 months after cardiac transplant. PTCA was successful (greater than or equal to 20% change in vessel diameter) in 13 of 17 (76%) lesions (the degree of prePTCA stenosis was 84% +/- 3% vs. 40% +/- 4% postPTCA; p less than or equal to 0.01). Multiple PTCA procedures were performed for progressive coronary artery disease in two patients; in one patient, two procedures were 13 months apart, and, in the second patient, another three procedures were 2 and 6 months apart. Indications for PTCA included reversible thallium perfusion defects, segmental left ventricular wall-motion abnormalities, or both in the distribution of proximal coronary artery stenoses. No deterioration occurred in the four unsuccessful PTCA attempts (two patients with initial total occlusion, and two patients in whom the lesion could not be crossed with a guidewire). Noninvasive evidence of ischemia was improved immediately after PTCA in all cases. Three patients remain alive 5, 7, and 11 months, respectively, after PTCA without evidence of new ischemia. One patient died 39 months after his first PTCA, while another patient was retransplanted 8 months after the first PTCA. Thus, PTCA can be performed in cardiac transplant patients with proximal major vessel coronary artery disease and may prolong cardiac homograft function.(ABSTRACT TRUNCATED AT 250 WORDS)
Vetrovec
G W
GW
Department of Medicine, Medical College of Virginia, Richmond 23298.
Cowley
M J
MJ
Newton
C M
CM
Lewis
S A
SA
DiSciascio
G
G
Thompson
J A
JA
Hastillo
A
A
Lower
R
R
Hess
M
M
D000328:Adult; D000800:Angioplasty, Balloon; D003327:Coronary Disease / Q000209:etiology / Q000628:therapy*; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D012008:Recurrence; D012086:Reoperation