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Coronary artery involvement in chronic graft-versus-host disease presenting as sudden cardiac arrest
Da Hyun Kim1, Jung Jin You1, Ho Joon Im1
1Department of Pediatrics, Asan Medical Center Children's Hospital, Ulsan University College of Medicine, Seoul, Korea.
Insights
Graft-versus-host disease (GVHD) can cause rare but fatal coronary artery obstruction in children after stem cell transplants. This case highlights GVHD as a potential cause of pediatric cardiac events.
Area of Science:
- Pediatric Cardiology
- Hematology
- Immunology
Background:
- Allogeneic hematopoietic stem cell transplantation (HSCT) can lead to graft-versus-host disease (GVHD).
- Cardiac complications are infrequent sequelae of GVHD, with coronary artery involvement being exceptionally rare.
Observation:
- A pediatric patient with chronic GVHD experienced sudden cardiac arrest 30 months post-HSCT.
- Clinical presentation included ventricular fibrillation, with ECG findings suggestive of acute coronary syndrome.
- Coronary angiography revealed significant obstructions in multiple coronary arteries.
Findings:
- The patient had no conventional risk factors for coronary artery disease.
- The observed coronary artery obstruction was attributed to chronic GVHD.
- This represents an unusual manifestation of GVHD in a pediatric patient.
Implications:
- Coronary artery involvement should be considered a potential manifestation of chronic GVHD in pediatric patients.
- This case underscores the importance of recognizing rare cardiac complications following HSCT.
- Further research may be needed to understand the mechanisms and prevalence of GVHD-related coronary artery disease.
Abstract:
Graft-versus-host disease (GVHD) is related to considerable morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Cardiac complications associated with GVHD are uncommon, and coronary artery involvement is even more unusual. We report on a male pediatric patient with chronic GVHD who developed a fatal ventricular arrhythmia caused by coronary artery obstruction after HSCT. At 30 months after HSCT, he suddenly collapsed with ventricular fibrillation. After resuscitation, electrocardiography showed abnormal q-wave and ST changes in the inferior leads, suggesting a coronary event. Coronary angiography revealed complete obstruction of the proximal left anterior descending artery, subtotal obstruction of the mid left circumflex artery, and mild narrowing at the right coronary artery. This boy had none of the risk factors for coronary artery disease, and the only possible explanation for the cardiac event is GVHD. Coronary artery disease only rarely occurs as a cardiac event in children. However, coronary artery involvement should be recognized as one of the important manifestations of chronic GVHD in children.
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