The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Case Report

The Role of Multiple Drug-Eluting Stents in the Treatment of Cardiac Transplant Vasculopathy

Authors: Rajeev Garg, MD, Avneet Singh, MD, Kul Aggarwal, MD

Abstract

A 60-year-old male with cardiac transplantation six years prior was seen for easy fatigability and dyspnea on exertion. Electrocardiogram revealed new T-wave inversions in the anterolateral leads. Cardiac catheterization showed diffuse multivessel disease with significant stenosis consistent with cardiac transplant vasculopathy (CTV). Percutaneous intervention was performed with DES with improvement of symptoms. Follow-up cardiac catheterization revealed patent stents. CTV is the most common cause of death in heart transplant patients. Due to denervated heart, these patients rarely experience chest pain. Revascularization options are limited given the diffuse nature of the disease. Due to their very low restenosis rates, DES may represent a viable alternative to retransplantation.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Uretsky BF, Murali S, Reddy PS, et al. Development of coronary artery disease in cardiac transplant patients receiving immunosuppressive therapy with cyclosporine and prednisone. Circulation 1987;76:827–834.
 
2. Kobashigawa JA. Coronary artery disease in the transplanted heart: why does it happen and what can we do about it? Cardiol Rev 1996;4:1–11.
 
3. Chamorro CI, Almenar L, Martínez-Dolz L, et al. Do cardiovascular risk factors influence cardiac allograft vasculopathy? Transplant Proc 2006;38:2572–2574.
 
4. Smart FW, Ballantyne CM, Cocanougher B, et al. Insensitivity of noninvasive tests to detect coronary artery vasculopathy after heart transplant. Am J Cardiol 1991;67:243–247.
 
5. Akosah KO, Mohanty PK, Funai JT, et al. Noninvasive detection of transplant coronary artery disease by dobutamine stress echocardiography. J Heart Lung Transplant 1994;13:1024–1038.
 
6. Derumeaux G, Redonnet M, Soyer R, et al. Assessment of the progression of cardiac allograft vasculopathy by dobutamine stress echocardiography. J Heart Lung Transplant 1998;17:259–267.
 
7. Lewis JF, Selman SB, Murphy JD, et al. Dobutamine echocardiography for prediction of ischemic events in heart transplant recipients. J Heart Lung Transplant 1997;16:390–393.
 
8. Yeung AC, Davis SF, Hauptman PJ, et al. Incidence and progression of transplant coronary artery disease over 1 year: results of a multicenter trial with use of intravascular ultrasound. Multicenter Intravascular Ultrasound Transplant Study Group. J Heart Lung Transplant 1995;14(6 pt 2):S215–S220.
 
9. Benza RL, Zoghbi GJ, Tallaj J, et al. Palliation of allograft vasculopathy with transluminal angioplasty: a decade of experience. J Am Coll Cardiol 2004;43:1973–1981.
 
10. Yoon EJ, Haeusslein E, Brent B. Long-term follow up after coronary sirolimus drug-eluting stent implantation for cardiac transplant arteriopathy. J Invasive Cardiol 2006;18:184–185.
 
11. Tanaka K, Li H, Curran PJ, et al. Usefulness and safety of percutaneous coronary interventions for cardiac transplant vasculopathy. Am J Cardiol 2006;97:1192–1197.
 
12. Bader FM, Kfoury AG, Gilbert EM, et al. Percutaneous coronary interventions with stents in cardiac transplant recipients. J Heart Lung Transplant 2006;25:298–301.
 
13. Matos G, Steen L, Leya F. Treatment of unprotected left main coronary artery stenosis with a drug eluting stent in a heart transplant patient with allograft vasculopathy [review]. Heart 2005;91:e11.
 
14. King SB III, Smith SC Jr, Hirshfeld JW Jr, et al. 2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention. J Am Coll Cardiol 2008;51:172–209.
 
15. Grines CL, Bonow RO, Casey DE Jr, et al. Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. J Am Coll Cardiol 2007;49:734–739.
 
16. Lüscher TF, Steffel J, Eberli FR, et al. Drug-eluting stent and coronary thrombosis: biological mechanisms and clinical implications. Circulation 2007;115:1051–1058.