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Efficacy of augmented immunosuppressive therapy for early vasculopathy in heart transplantation

Rubén Lamich^a, Manel Ballester, MD^a, Vicens Martí^a, Vicens Brossa^a, Rosa Aymat^a, Ignasi Carrió^*, Lluis Bernà^*, Marta Campreciós^a, Mireia Puig^a, Montserrat Estorch^*, Albert Flotats^*, Ramón Bordes, Juan Garcia^a, Josep M. Augè^a, Josep M. Padró^a, Josep M. Caralps^a and Jagat Narula

^a Cardiomyopathy and Heart Transplantation Program, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
^* Service of Nuclear Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Department of Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Cardiac Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA

View larger version (73K): [in a new window]   Figure 1 Angiographic evidence of early graft vasculopathy that responded to increased immunosuppressive therapy. Coronary angiography in left anterior oblique view in patient #1 demonstrated diffuse coronary artery disease 2 months after transplantation (A). The angiographic evidence of vasculopathy was also accompanied by anterior myocardial perfusion defect. The angiographic abnormality showed resolution with augmented immunosuppression. There was a complete resolution of scintigraphic perfusion abnormality. The patient continues to show angiographically normal coronary arteries 126 months after operation.

View larger version (150K): [in a new window]   Figure 2 Histologic evidence of vasculitis. Endomyocardial biopsy specimen 1 month after heart transplantation in patient #10. A myocardial arteriole demonstrates evidence of vasculitis with intimal proliferation and edema almost obliterating the lumen (hematoxylin and eosin, x200). In addition to vasculitis, there was an evidence of ISHLT grade 3A parenchymal rejection (B). This patient demonstrated anterior myocardial perfusion abnormality in thallium perfusion scan. He was treated with increased immunosuppressive therapy with complete resolution of perfusion defect. This patient demonstrated normal coronary arteries at 34 months, when he died of a cerebrovascular accident.