Heart transplant coronary artery disease: Multimodality approach in percutaneous intervention

Abstract

Coronary artery disease is the most important cause of late morbidity and mortality after heart transplantation. It is usually an immunologic phenomenon termed cardiac allograft vasculopathy, but can also be the result of donor-transmitted atherosclerosis. Routine surveillance by coronary angiography should be complemented by intracoronary imaging, in order to determine the nature of the coronary lesions, and also by assessment of their functional significance to guide the decision whether to perform percutaneous coronary intervention. We report a case of coronary angiography at five-year follow-up after transplantation, using optical coherence tomography and fractional flow reserve to assess and optimize treatment of coronary disease in this challenging population.

Keywords: Cardiac allograft vasculopathy; Coronary artery disease; Doença coronária; Fractional flow reserve; Heart transplantation; Intervenção coronária percutânea; Optical coherence tomography; Percutaneous coronary intervention; Tomografia de coerência ótica; Transplante cardíaco; Vasculopatia do enxerto.