Early visualization of cardiac allograft vasculopathy with Optical coherence tomography (OCT) in Pediatric heart transplant recipients

Introduction: Cardiac allograft vasculopathy (CAV) is the main cause of graft failure after pediatric heart transplantation (HTx). Patients with CAV typically present late with loss of allograft function or sudden death. Therefore, it is important to identify asymptomatic patients early, but coronary angiography might miss early changes. Optical coherence tomography (OCT) might be used for early diagnosis of CAV.

Method: OCT uses a near infrared light capturing micrometer resolution with three-dimensional imaging and was used in Pediatric HTx-patients in addition to angiographic and histological assessment. OCT was used through a 5 Fr. guiding cath. in either RCA or LCA or both.

Results: OCT could be performed in 25 patients during 2012-2014. Median age was 7.8 (4.6 to 10.9) years; median posttransplant time was 5.9 (4.5 to 10.2) years. OCT was performed in all patients without serious complications. Significant intimal thickening (see figure), medial hypertrophy and overall luminal changes were detected in 18/25 patients, whereas most of these lesions were not detectable by angiography.

Conclusions: It is possible to perform OCT in pediatric HTx recipients > 15 kg. OCT is a promising view into coronary vascular pathology besides angiography and intravascular ultrasound (IVUS). CAV, hidden for angiographic detection, might be illuminated with this method earlier and its clinical impact needs to be studied.