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Accelerated allograft coronary artery disease remains the major cause of mortality after the first year of transplantation. Despite the extensive use of stents and angioplasty in coronary artery disease, there is a paucity of data about the efficacy of such interventions in orthotopic heart transplants. The authors herein report the outcome of those patients in their institution who had undergone percutaneous coronary artery angioplasty and stenting at a late stage of their transplantation. Within a 12-year period, 106 adult patients underwent orthotopic heart transplantation at their institution. Eight of these patients with 17 lesions underwent deployment of nine stents and eight angioplasties 8.1 ±3.2 years posttransplantation. There were 15 denovo and two restenotic lesions. The indications for intervention were presence of symptoms in five patients and severity of lesions in three asymptomatic patients detected on their follow-up angiogram. All patients had angiographic worsening of lesions at their follow-up angiogram. The initial procedural success for both stented and angioplastied lesions was 100%. Within a mean angiographic follow-up of 261 days, all balloon angioplastied lesions had developed restenosis, whereas within a mean period of 67 days, 50% of stented lesions had developed restenosis. On the follow-up angiogram, deterioration of the nontreated segments were noted throughout the coronary arterial tree; however, the immediate proximal and distal parts of the target segments demonstrated an exaggerated hyper proliferative response as compared to other sites. The overall median time to the detection of restenosis for both stented and angioplastied lesions was 5.2 months (inner quartile 2.5-6.2 months). The authors conclude that angioplasty and stenting late in the course of transplantation is associated with a significant restenosis rate and in such patients earlier or alternative catheter-based interventions must be considered.

There is interest in the role of growth factors in the genesis of arterial remodeling. We studied local administration of basic fibroblast growth factor (bFGF) to coronary lesions to determine whether there is a difference in remodeling and whether neovascularization could be induced in such stenoses and distal myocardium. Pigs were randomized to balloon infusion of either saline or bFGF at each thermally injured arterial site. After the animals were killed, their internal elastic lamina, neointima, and lumen areas were measured. Capillaries were counted in the arteries and myocardium. There was a greater loss of lumen and internal elastic lamina in the bFGF group. The neointima, media, and myocardium in the bFGF treated arteries had statistically more capillaries. This study showed that local intracoronary bFGF, at a dose that results in arterial luminal revascu larization in injured segments, adversely affects arterial remodeling. Thus, the angio genic response to exogenous bFGF may be offset by concomitant shrinkage of injured arterial segments.

Aneurysms and ectasias of saphenous vein grafts are infrequent complications of coronary artery bypass surgery. They usually present as an expanding asymptomatic mediastinal mass on chest x-ray film or computed tomography scan. Though rare, they must be excluded from the differential diagnosis of mediastinal masses to avoid potentially dangerous needle biopsy. The authors describe ectasia of a saphenous vein graft in a 62- year-old man 14 years after coronary artery bypass surgery. The relevant literature is also discussed.