A 77-year-old, non-allergic, ex-smoker male patient with a history of cardiomyopathy of alcoholic origin underwent an orthotopic heart transplantation nine years ago.
Functional class NYHA I since the last annual review.
The electrocardiogram showed normal sinus rhythm at 95 beats per minute (lpm), signs of left atrial dilatation and bifascicular block with right bundle branch block and left bundle branch hemiblock.
The chest X-ray showed midline incision sutures, atheromatosis at the footing level and cardiovascular silhouette within normal limits.
A slightly hyperintense thorax suggestive of pulmonary emphysema with bilateral hiliar prominence that seemed vascular was described.
Transthoracic echocardiographic study showed that the global and regional systolic function of the transplanted heart were preserved (ejection fraction, EF: 0.61).
A telediastolic volume (VTD) of 73 ml, telesystolic volume (TSV) of 28 ml and myocardial mass of 93 grams were estimated.
The ventricular filling pattern was typical of the heart.
No signs of elevated filling pressure were observed.
Dobutamine-stress echocardiography was normal.
The ischemia provocation test was negative for myocardial ischemia.
In order to study the coronary arteries and rule out graft vasculopathy, a coronary angiography was performed using TCDF with the following parameters: 120 kV, 350 mAs effective for each tube, CTDIvol= 41.
70 ml of contrast agent (Iomeron 400, 400 mgI/ml, Bracco, Milano, Italy) were administered through a right antecubital vein.
During examination, the mean heart rate of the subject was 80 bpm (range 78-83 bpm).
The apnea lasted eight seconds.
This examination showed left dominance with normal coronary arteries without significant stenosis.
The right coronary artery was thin, especially in its middle and distal thirds.
An intermediate branch or bisector was observed as anatomical variant.
The calculation of left ventricular function by TCDF showed parameters comparable to those obtained by echocardiography.
Cardiac function was within normal limits with EF: 0.61, VTD 61 ml, VTS 24 ml and myocardial mass of 88 grams.
No regional contractility abnormalities were observed.
Since stress echocardiography was negative for myocardial ischemia and non-invasive coronary angiography by TCDF showed normal epicardial coronary arteries, conventional coronary angiography was ruled out.
