Korean J Transplant.  2022 Jun;36(2):154-158. 10.4285/kjt.22.0006.

Intractable right coronary artery spasm in the early postoperative period after heart transplantation: a case report

• Chung J
• Kang J
• Lee HY
• Sohn SH
• Hwang HY
• Cho HJ

• KMID: 2531140
• DOI: http://doi.org/10.4285/kjt.22.0006

Abstract

Coronary artery spasm after heart transplantation is a very rare complication. In one observational study and many anecdotal reports, most cases of coronary artery spasm occurred more than 1 year after surgery and had good outcomes. However, cases of intractable coronary artery spasm during the early postoperative period resulting in fatality are limited. This report presents a case of two cardiac arrests caused by coronary artery spasms within a short period of time after heart transplantation.

Keyword

Heart transplantation; Coronary vasospasm; Coronary angiography; Intravascular ultrasound; Myocardial revascularization; Case reports

Figure

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  Fig. 1 Electrocardiogram (ECG) during hospitalization. (A) Normal ECG after cardiac transplantation. (B) ECG after the first cardiac arrest, indicating inferior ST-segment elevation myocardial infarction (STEMI). (C) ECG after stent implantation to the right coronary artery with a stabilized ST segment. (D) ECG after the second cardiac arrest, indicating inferior STEMI.

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  Fig. 2 Coronary angiography (CAG) and intravascular ultrasound after cardiac arrest. (A) CAG of the right coronary artery (RCA) before stent implantation revealed multiple vasospasm. (B) Intravascular ultrasound of the proximal RCA found a large plaque burden (up to 75.5%). (C) A drug-eluting stent was implanted into the proximal RCA. (D) CAG of the RCA after the second cardiac arrest revealed a severe diffuse coronary spasm, except in the area of the stent-implanted proximal lesion.

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