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1、心脏移植长期存活患者冠状动脉病变一例中华器官移植杂志2004年5月第25卷第3期ChinJOrganTransplant,May2004,v_01.25,No.3心脏移植长期存活患者冠状动脉病变一例陈良万吴锡阶黄雪珊陈道中陈良龙林朝贵林峰王齐敏黄忠耀邱罕凡曹华戴小福【摘要】目的探讨1例心脏移植长期存活患者冠状动脉病变的原因,诊断和处理.方法对1例心脏移植术后存活8年的患者进行长期随访.结果术后患者生活质量好,恢复正常工作;血液生化正常;心电图无心肌缺血改变;肱动脉内皮依赖性血管舒张功能正常:心内膜心肌活检未见急性排斥反应征象;同位素心肌显像提示左室壁心肌放射性分布进行性减低;冠状动
2、脉造影显示左冠状动脉弥漫性狭窄,右冠状动脉近段有一局限性严重狭窄(>90%),远端为轻度弥漫性狭窄,行右冠状动脉近段成形和支架植入,同位素心肌显像示左室壁心肌放射性分布明显改善.结论慢性排斥反应可能是导致移植心冠状动脉病变的重要原因;定期行同位素心肌显像检查有助于了解心肌血液供应;严重的局限性冠状动脉病变可应用冠状动脉成形和支架植入予以治疗.【关键词】心脏移植;冠状动脉疾病Coronaryarterialdiseaseinonelong-termsurvivorreceivinghearttransplantationCHENLiang-wan,WUXi-jie,HUANGX
3、ue-shan,eta1.DepartmentofCardiacSurgery,UnionHospital,FujianMedi—calUniversity,zhou350001.Cina【Abstract】ObjectiveTostudythepossiblecauseandthefeasibilityofdiagnosisandtreatmentofcoronarydiseaseafterhearttransplantation.MethodsAn8-yearsurvivorofhearttransplantationreceivedclosefollow—up.Theclin
4、icalsymptomswererecorded.Bloodlaboratorytests,electrocardiogram,endomy—oc.ardialbiopsy,leftventricularTcscintigraphy,endothelium—dependentvasodilatationofthebrachialarteryandcoronaryangiographywereperformed.ResultsThepatienthadgocdlifequalitywithoutanysyrup—tomssuchaSchestdiscomfort,palpitatio
5、n,dyspnea.Serumlipidandlipoproteinlevelsremainednormalrange.Noanymyocardialischemicsignsweredetectedinelectrocardiogram.Endothelium—dependentva—sodilatationwasnorma1.NoanyacuterejectivemanifestationWaSobservedinendomyocardialbiopsysam—plesLeftventricularTcscintigraphyshowedthatleftventricularw
6、allperfusionWaSprogressivelyde—creased.Coronaryangiographyshowedthatatypicalvasculopathywithdiffusestenosisinvolvedallcoronarybrachestosomeextentandfightcoronaryhadaproximallocalseverestenosiswithdistalmilddiffusesteno—sis.CoronaryangioplastyandstentplacementofproximalfightcoronaryWaSperformed
7、.TheperfusionoftheleftventrleularwallwasimprovedbythisangioplaSty.ConclusionChronicre~ectionisprobablythemaincaUSeofcoronarydiseaseafterhearttransplantation.Serial1eftventricularscintigraphycandetectthechangeofmyocardialperfusion.Locals
