Safety of optical coherence tomography 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.