Detection of Cardiac Allograft Vasculopathy with the New Optical Coherence Tomography in Pediatric Heart Transplant Recipients – Initial Experience

Abstract

Purpose Cardiac allograft vasculopathy (CAV) is the main cause of graft failure in heart transplant (HTx) recipients. Coronary angiography remains the principal tool for CAV in most institutions. However, coronary angiography might miss CAV. Optical coherence tomography (OCT) might be used for visualisation of coronary pahtology in HTx recipients. Methods and Materials OCT is using near infrared light capturing micrometer resolution with three-dimensional imaging. OCT was used with the 5 Fr. Guiding catheter over a 0.014inch guide wire in the left and right coronary artery. OCT was used with a blood free pullback (20 mm/sec) with 100 frames per second, where axial resolution was 15 μm. Angiographic and histological assessment of coronary vascular status was performed. Results We report our initial experience (n=7) with intracoronary OCT in pediatric HTx-recipients. Median age was 7.8 (4.6 – 10.9) years; median posttransplant time was 6.9 (4.5-10.2) years. OCT was performed in all patients without complications. We could detect intimal thickening (see figure ), medial hypertrophy and overall luminal changes several patients, whereas all lesions were not detectable by angiography. These lesions still have to be analyzed for clinical relevance. Conclusions It is possible to perform OCT in pediatric Htx recipients above 15kg of BW. OCT delivers impressive and promising insight into the coronary arteries besides angiography and with an improved resolution, if compared to intravascular ultrasound (IVUS). Vascular pathology hidden for angiographic detection might be illuminated with this method and its clinical relevance needs to be studied.