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Serial coronary angioplasty for atherosclerosis following heart transplantation.

A 51-year-old man underwent orthotopic heart transplantation for end-stage ischemic cardiomyopathy. Forty-six months after the operation significant coronary artery disease was demonstrated in the allografted heart, with severe (90% to 95%) proximal stenosis of the left anterior descending artery as well as diffuse distal and smaller branch lesions. Percutaneous transluminal coronary angioplasty of the proximal left anterior descending artery lesion was successfully performed, reducing the stenosis to a 20% to 30% narrowing. Sixteen months later, repeated angiography showed sustained improvement of the proximal left anterior descending artery lesion and development of new significant lesions in the mid-left anterior descending and left circumflex coronary arteries. Coronary angioplasty of the mid-left anterior descending and proximal circumflex artery lesions was successfully performed and an angiogram four months later showed continued angiographic improvement at each of the distal sites. This case represents the first reported coronary artery angioplasty in a heart transplant recipient. It demonstrates the successful application of a non-operative myocardial revascularization procedure using percutaneous transluminal coronary angioplasty to achieve sustained palliation of significant coronary artery disease following heart transplantation.