Early detection of cardiac allograft vasculopathy and chronic rejection after heart transplantation-Report of one case / 中华器官移植杂志

ABSTRACT

Objective To study clinically the feasibility of early diagnosis of cardiac allograft vascularopathy (CAV) and chronic rejection. Methods A 13 year old female patient with dilated cardiomyopathy received orthotopic heart transplantation for advanced heart failure, and subsequent immunosuppressive therapy including cyclosporine, prednisone and mofetil, and a monthly close follow up. Coronary angiography and left ventricular endomyocardial biopsy (EMB) was performed 9 months after the operation. Results The clinical and follow up data of the case showed that cardiac or systemic nonspecific symptoms such as exertional chest discomfort, palpitation, fatigue or fever of unknown reasons were the first and ignorable clinical symptoms, and found disappeared after dosage addition of cyclinsporine, which indicated a early clinical manifestations of rejection or vasculopathy. While persistent sinus tachycardia on electrocardiogram, decreased left ventricular ejection fraction (from 64?% ～68?% down to 47?%～50?%), enlarged right atrial (from 32～ 41?mm up to 44?mm in diameter), thickened intraventricular septal ( 13?mm ), repetitive tricuspid regurgitation on echocardiography, increased white blood cells without infection were observed respectively. Coronary angiography showed a typical (type B) vasculopathy with diffuse concentric stenosis of mid and distal left anterior descending artery and its small braches, the distal diagonal, circumflex, and right coronary artery were also involved to some extent. Furthermore, early mild chronic rejection of grade I A was proved by pathologic study. Conclusion Close clinical observation and follow up, serial echocardiography and electrocardiogram, reaction to enhanced anti rejection, and other related laboratory methods could be analyzed and colligated for early noninvasive diagnosis of cardiac allograft vasculopathy and chronic rejection, while EMB and coronary angiography are still the precise diagnostic ways.