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Safety of optical coherence tomography in pediatric heart transplant patients
Sarah M Ulrich1, Anja Lehner1, Julia Birnbaum1
1Department of Pediatric Cardiology, Ludwig-Maximilians-University of Munich, Germany.
Insights
Optical coherence tomography (OCT) is a safe intravascular imaging method for diagnosing early cardiac allograft vasculopathy (CAV) in children after heart transplantation, even in those weighing as little as 15kg.
Area of Science:
- Cardiology
- Pediatric Transplantation
- Medical Imaging
Background:
- Cardiac allograft vasculopathy (CAV) significantly impacts long-term graft survival post-heart transplantation in children.
- Early diagnosis of CAV is critical for donor heart preservation but challenging due to asymptomatic progression and arterial changes.
- Intravascular imaging modalities like optical coherence tomography (OCT) show promise for early CAV detection.
Purpose of the Study:
- To evaluate the safety and utility of OCT in diagnosing early-stage CAV in pediatric heart transplant recipients.
- To assess the feasibility of OCT in children, considering factors like weight and procedural risks.
Main Methods:
- Retrospective analysis of 50 OCT procedures performed on pediatric heart transplant patients between June 2013 and March 2016.
- Comparison of OCT findings with coronary angiography results.
Main Results:
- OCT was safely performed in 37 pediatric patients, including a 4-year-old weighing 15kg, with no procedural complications.
- Early CAV (Stanford I or II) was identified by OCT in 26 cases.
- Coronary angiography revealed mild changes in only four of the 26 cases diagnosed with early CAV by OCT.
Conclusions:
- Optical coherence tomography (OCT) is a safe and effective intravascular imaging technique for pediatric heart transplant recipients.
- OCT can be utilized in children weighing as little as 15kg without increased procedural risk.
- OCT facilitates the early diagnosis of cardiac allograft vasculopathy in pediatric heart transplant patients.
Background:
Cardiac allograft vasculopathy (CAV) is a crucial problem after heart transplantation, in adults as well as in children. CAV is the main risk factor for a reduced long-term graft survival. The early diagnosis and treatment of CAV is essential for a successful long-term preservation of the donor heart. However, asymptomatic progression of CAV and concentric hyperplasia of the coronary arteries may complicate the early diagnosis by conventional measures. Intravascular imaging, such as intravascular ultrasound and optical coherence tomography (OCT), enables the diagnosis of early stage CAV. To date, there is little known about OCT in children. We present our single center experience with OCT after pediatric heart transplantation.
Methods:
Retrospective analysis of OCT (n=50) after pediatric heart transplantation between June 2013 and March 2016 and comparison between angiographic appearance and OCT.
Results:
37 patients underwent optical coherence tomography, nine patients were examined twice and two patients tree times. The youngest patient at time of examination was 4years with a weight of 15kg (mean 50.86kg, range 15 to 88kg). There were no complications, especially no bleeding, no arrhythmias or myocardial ischemic events. Early CAV (Stanford I or II) was detected by OCT in 26 cases. Only in four of these cases, also the coronary angiography showed mild changes.
Conclusion:
OCT is a safe intravascular imaging method that can also be used in children after pediatric heart transplantation up to a minimum weight of 15kg without an increasing risk of a catheterization procedure.
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