Şeref Alp KÜÇÜKER, Haşmet BARDAKÇI, Oğuz TAŞDEMİR, Göktan AŞKIN, Süha KÜÇÜKAKSU, Onurcan TARCAN, Şekip ALTUNKAN, Nihan ERDOĞAN, Mehmet Ali ÖZATİK, Erol ŞENER

Kalp transplantasyonu sonrası allogreft vaskülopatisinin elektron beam tomografi ile değerlendirilmesi

Amaç: Kalp transplantasyonu sonrası uzun dönemde yaşamı kısıtlayan en önemli etkenlerden biri allogreftte meydana gelen koroner arter hastalığıdır. Koroner arter hastalığını saptamada elektron beam tomografisi (EBT) uygulaması yeni ve noninvaziv bir yöntemdir. Bu yöntemin kalp transplantasyonu yapılmış hastalardaki etkinliği araştırıldı Materyal ve Metod: Kliniğimizde Mayıs 1998 - Mayıs 2002 tarihleri arasında 18 kalp transplantasyonu gerçekleştirildi. Takipte 12 aylık süreyi aşan (14-48 ay) 5 hasta (4 erkek, l kadın) koroner arter hastalığı açısından EBT ile değerlendirildi ve görüntüleri kaydedildi. Hastalara işlemden l hafta sonra koroner anjiyografi ve transtorasik ekokardiyografi yapıldı. Bulgular: Hiçbir hastada her iki yöntemle de koroner arter hastalığı saptanmadı ve her iki işlemin sonuçları birbiriyle uyumlu bulundu. Ayrıca EBT ile hastaların ejeksiyon fraksiyonları değerlendirildi ve ekokardiyografik sonuçlarla uyumlu bulundu. Sonuç: Kalp transplantasyonu yapılan hastalarda orta ve uzun dönemde gözlenebilecek greft vaskülopatisinin takibinde koroner anjiyografi altın standart olmakla birlikte EBT yöntemi bu hasta grubunun takibinde uygulanabilecek alternatif bir noninvaziv tekniktir.

Evaluation of allograft vasculopathy with electron beam tomography following cardiac transplantation

Background: Coronary artery disease observed on the allogreft is one of the most important reasons limiting long term survival following cardiac transplantation. Electron beam tomography (EBT) is a new and noninvasive modality that can identify coronary artery disease Methods: Between May 1998 - May 2002, 18 heart transplant operations were perbimed in our clinic. Five (4 male, 1 female) of these patients having longer than 12 months of follow up (between 14 and 48 months) underwent EBT study. One week after the EBT study coronary angiography and transthoracic echocardiography studies were also done and results were compared with he results of EBT study. Results: None of the patients demonstrated coronary artery disease with both visualisation method. Ejection fraction analysis made with eehocardiography and EBT were comparable Conclusions: Although coronary angiography is considered as gold standart for determining greft vasculopathy in transplanted hearts, EBT is a noninvasive alternative and can be used among transplant cohorts.

PDF

___

1. Hoserpud JD, Bennett LE, Keck BM, Fiol B, Boucek MM, Novich RJ. The registry of the International Society for Heart and Lung Transplantation: Sixteenth official report- 1999. J Heart Lung Transplant 1999;18:611-26.
2. St Goar FG, Pinto FJ, Alderman El, et al. Intracoronary ultrasound in cardiac transplant recipients: In vivo evidence of "angiographically silent" intimal thickening. Circulation 1992;85:979-87.
3. Smart FW, Ballantyne CM, Cocanougher B, et al. Insensitivity of noninvasive tests to detect coronary artery vasculopathy after heart transplantation. Am J Cardiol 1991;67:243-7.
4. Legare SF, Haddad H, Barnes D, Sullivan JA, Buth KJ, Hirsch G. Myocardial scintigraphy correlates poorly with coronary angiogrâphy in the screening of transplant arteriosclerosis. Can J Cardiol 2001; 17:866-72.
5. Budoff MJ, Georgiov D, Brody A, et al. Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease. Circulation 1996;93:898-904.
6. Barbir M, Bowker T, Ludman P, Mitchell A, Woud D, Yacoub M. Ultrafast computed tomography scanning for detection of coronary disease in cardiac transplant recipients. Am J Cardiol 1994;74:941-4.
7. Knollmann FD, Bocksch W, Spiegelsberger S, Hetzer R, Felix R, Hummel M. Electron-Beam Computed Tomography in the assesment of coronary artery disease after heart transplantation. Circulation 2000; 101:2078-82.
8. Hoff J, Chomka EV, Krainik AJ, Daviglus M, Rich S, Kondos GT. Age and gender distributions of coronary artery calcium detected by electron beam tomography in 35246 adults. Am J Cardiol 2001;87:1335-9.
9. Rumberger JA, Sheedy PF, Breen JF, Schwartz RS. Electron beam computed tomographic coronary calcium score cutpoints and severity of associated angiographic lumen stenosis. J Am Coll Cardiol 1997;29:1542-8.
10. Pflugfelder PW, Boughner DR, Rudas L, Koştuk WJ. Enhanced detection of cardiac allograft arterial disease with intracoronary ultrasonographic imaging. Am Heart J 1993;125:1583-91.
11. Ventura H, White CJ, Jain A, Staleton DD, Collins TJ, Ramee SR. Assessment of intracoronary morphology in cardiac transplant recipients by angioscopy and intravascular ultrasound. Am J Cardiol 1993;72:805-9.
12. Bielak LF, Kaufmann RB, Moll PP, McCollough CH, Swartz RS. Small lesions in the heart identified at electron beam CT: Calcification or noise? Radiology 1994;192:631-6.
13. Wexler L, Brundage B, Crouse J, et al. Coronary artery calcification: Pathophysiology, epidemiology, imaging methods, and clinical implications. Circulation 1996;94:1175-92.
14. Mautner GC, Mautner SL, Froehlich J, et al. Coronary artery calcification: Assessment with electron beam CT and histomorphometric correlation. Radiology 1994; 192:619-23.
15. Boumgart D, Schermund A, Goerge G, et al. Comparison of electron beam computed tomography with intracoronary ultrasound and coronary angiography for detection of coronary atherosclerosis. J Am Coll Cardiol 1997;30:57-64.
16. Arad Y, Spadaro LA, Goodman K, et al. Predictive value of electron beam computed tomography of the coronary arteries. Circulation 1996;93:1951-3.
17. Halle AA III, DiSciascio G, Massin EK, et al. Coronary angioplasty, atherectomy and bypass surgery in cardiac transplant recipients. J Am Coll Cardiol 1995;26:120-8.
18. Callister TG, Raggi P, Cooil B, Lippolis NJ, Russo D. Effect of HMG CoAreductase inhibitors on coornary artery disease as assessed by eletron-beam computed tomography. N England J Med 1998;339:1972-8.