Читать книгу Interventional Cardiology - Группа авторов - Страница 113

The guidelines for management of heart transplant recipients consider coronary angiography the gold standard method to detect cardiac allograft vasculopathy, which ranges from 42% at 5 years to 50% at 10 years. These patients do not experience typical angina due to the the denervation of the transplanted heart [9].

In patients with orthotopic heart transplant the coronary angiography is technically difficult due to the presence of the aortotomy with anomalous implantation of the coronary ostia and to the position of the allograft. A transfemoral approach is usually preferred and its superiority was confirmed in a small, randomized study. [10]

In heterotopic heart transplant the heart of the donor and recipient are sewed in a parallel fashion. Nowadays, its role is limited to the presence of high pulmonary hypertension in patients who cannot receive a combined heart and lung transplant or in the case of significant donor‐recipient body size mismatch. A 1994 study showed that the success cannulation rate was 67%, that the preferred access was the femoral and that the most helpful angiographic views were the posterior‐anterior, left anterior oblique, and caudal right anterior oblique [11].