RESUMO
The purpose of this study was to evaluate long-term changes of transplant coronary arteries, including vessel, plaque, and lumen areas. There are limited long-term data on vessel remodeling after heart transplantation. We analyzed serial intravascular ultrasound images of the left anterior descending coronary artery (LAD) in 54 heart transplantation recipients. Nine patients (16.7%) had a history of rejection. Proximal left anterior descending artery segments were matched among time points, a ≥20-mm long segment was analyzed every 1 mm, and results were normalized for analysis length and reported as mm(3)/mm. During follow-up, vessel area decreased (-0.48 ± 1.3 mm(3)/mm/year), and plaque area did not change (-0.01 ± 0.47 mm(3)/mm/year). As a result, lumen area decreased (-0.52 ± 1.34 mm(3)/mm/year). The change in mean lumen area was well correlated to the change in mean vessel area (r = 0.94, p <0.01) but not to the change in mean plaque area (r = -0.27, p = 0.05). In conclusion, lumen loss occurred during long-term follow-up of patients who underwent heart transplantation, primarily secondary to negative remodeling (decrease in vessel dimensions).
Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Transplante de Coração , Transplantados , Ultrassonografia de Intervenção/métodos , Remodelação Vascular , Adulto , Angiografia Coronária , Doença da Artéria Coronariana/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
INTRODUCTION: Heart transplantation is the "gold standard" in the treatment of patients with end-stage heart failure who satisfy strict selection criteria. METHODS: We reviewed ten years' clinical experience (1996-2006) from 53 orthotopic transplants in our centre. RESULTS: Low perioperative (3.7%) and long-term (7.5%) mortality rates yielded a 95% survival rate in the first year, 92% at five years, and 70% at ten years--significantly better than the corresponding rates worldwide. In addition, excellent functional recovery was achieved in all transplant recipients. CONCLUSIONS: The strict application of international criteria in the selection of both candidates and donors, together with uninterrupted, multidisciplinary follow up, have made it feasible to perform heart transplantation with excellent results, despite the curiously low number of potential recipients and the shortage of acceptable donor hearts.