Serial intracoronary ultrasound in children: feasibility, reproducibility, limitations, and safety

Area of Science:

• Pediatric Cardiology
• Vascular Imaging
• Interventional Cardiology

Background:

• Pediatric heart transplant recipients and patients with Kawasaki disease face elevated risks of coronary artery disease.
• Coronary angiography often underestimates vasculopathy in transplant patients and intimal changes in Kawasaki disease.
• Intracoronary ultrasound (ICUS) is established for adult histopathologic assessment but lacks pediatric data.

Purpose of the Study:

• To evaluate the safety and efficacy of ICUS in pediatric patients.
• To assess ICUS's ability to detect sub-angiographic coronary artery disease in children.
• To provide sequential data on ICUS use in pediatric populations.

Main Methods:

• Thirty-two pediatric patients (ages 2.5-22 years) underwent 62 ICUS examinations during coronary angiography.
• ICUS images were correlated with angiographic findings.
• Analysis focused on intimal hyperplasia and luminal dimensions, assessing sensitivity for vessel wall disease.

Main Results:

• ICUS demonstrated higher sensitivity than angiography in detecting coronary vessel wall disease.
• Coronary vasospasm occurred in 11/62 studies post-ICUS, mostly asymptomatic and resolving with nitroglycerin.
• ICUS identified vasculopathy and intimal disease at angiographically normal sites.

Conclusions:

• ICUS is feasible, reproducible, efficacious, and safe in pediatric patients when using standard protocols and current technology.
• ICUS enables earlier detection of vasculopathy and intimal disease in children.
• Further research is needed to establish long-term safety and prognostic value in pediatric populations.