Ma. Kuhn et al., The medium-term findings in coronary arteries by intravascular ultrasound in infants and children after heart transplantation, J AM COL C, 36(1), 2000, pp. 250-254
Citations number
18
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
OBJECTIVES The study purposes were to determine 1) whether intravascular ul
trasound (IVUS) was more sensitive than angiography for the detection of po
st-transplant coronary artery disease (PTCAD) in pediatric patients; and 2)
whether those transplanted as neonates reacted differently than older pati
ents.
BACKGROUND Experience with IVUS for the diagnosis of PTCAD in children is l
imited.
METHODS Patients were divided into two groups: those transplanted as neonat
es (early group) and those transplanted in infancy or childhood (late group
). Morphometric analysis was performed, including maximal intimal thickness
(MIT) and intimal index (II). Stanford classification was used to grade le
sion severity. Acute rejection and cytomegalovirus (CMV) status were correl
ated with MIT and II.
RESULTS Thirty children were studied (early group, n = 13; late group, n =
17). All segments studied were angiographically normal. Mean MIT and mean I
I were significantly greater in the late group (0.26 +/- 0.14 vs. 0.13 +/-
0.03 mm, p < 0.001 and 0.11 +/- 0.07 vs. 0.07 1 0.03 mm, p = 0.04, respecti
vely). There was a significant correlation between MIT and II in those who
had acute rejection in the late group. Patients in the late group who were
CMV-positive had a significantly higher MIT compared with those in the late
group with negative serology (p = 0.04).
CONCLUSIONS Intravascular ultrasound was more sensitive than angiography in
detecting PTCAD after pediatric heart transplantation. There is a possible
role for acute rejection and CMV in the development of PTCAD. (C) 2000 by
the American College of Cardiology.