CORONARY ANGIOPLASTY FOLLOWING CARDIAC TR ANSPLANTATION

Coronary artery disease is a common complication of cardiac transplant ation threatening long term survival and its management is not well de fined. Percutaneous transluminal coronary angioplasty has been propose d as a palliative and exceptional technique in some patients with limi ted lesions. Of 145 patients undergoing cardiac transplantation betwee n April 1983 and January 1994, 7 underwent 10 coronary angioplasty pro cedures. The majority was performed in asymptomatic patients, 4 for an gigraphic abnormalities alone and 3 for documented painless ischaemia. Primary angiographic success was obtained in 90% (9 out of 10) of les ions. Complication included one acute occlusion and one arteriovenous fistula. Three patients died, 1, 8 and 10 months after angioplasty. Af ter an average of 24 months' follow-up, 3 (out of 7) patients had no c ardiac events (myocardial infarction, second angioplasty, second trans plantation or death). A multicentre prospective controlled trial is ne cessary to assess the impact of this procedure on graft and patient su rvival.