Optical coherence tomography for the evaluation of asymmetric cardiac allograft vasculopathy in a child
Steven C Greenway1, Martin Hosking, Kevin C Harris
1Section of Cardiology and Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada.
Insights
We report a pediatric case of cardiac allograft vasculopathy (CAV) primarily affecting the LAD artery. Optical coherence tomography (OCT) successfully identified silent disease, aiding in transplant decisions.
Area of Science:
- Pediatric cardiology
- Transplant medicine
- Cardiovascular imaging
Background:
- Cardiac allograft vasculopathy (CAV) is a significant concern in pediatric heart transplantation.
- Early detection and accurate assessment of CAV are crucial for patient management and long-term outcomes.
- Coronary angiography has limitations in detecting all stages of CAV, especially in smaller vessels.
Observation:
- A pediatric patient presented with isolated CAV in the left anterior descending (LAD) coronary artery.
- Sirolimus therapy appeared to halt the initial progression of the disease.
- Assessment of the right coronary artery (RCA) was critical for determining re-transplantation eligibility.
Findings:
- Coronary angiography alone was insufficient to fully evaluate the extent of CAV.
- Optical coherence tomography (OCT) was employed to detect angiographically silent CAV.
- OCT revealed a normal intravascular appearance of the RCA, providing reassurance.
Implications:
- OCT is a valuable tool for comprehensive CAV assessment in children, offering advantages over traditional angiography.
- Accurate assessment of CAV using OCT can prevent unnecessary re-transplantation listing.
- This case highlights the utility of advanced imaging in managing post-transplant complications in pediatric heart recipients.
Abstract:
We present an unusual case of CAV in a child with isolated disease in the LAD coronary artery. Initial progression of the disease appeared to have been halted by the use of sirolimus, but the assessment of disease in other vessels (particularly the RCA) was of particular importance in deciding whether or not to relist this patient for transplantation. Due to the known limitations of coronary angiography, we used OCT to assess for angiographically silent CAV. The normal intravascular appearance of the RCA by OCT was reassuring, and the child was not relisted for transplantation. OCT offers multiple advantages for the assessment of CAV in children.
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