Cardiac allograft vasculopathy

Cardiac transplantation has emerged as a valuable therapy for various end-s tage cardiac disorders. Cardiac allograft vasculopathy (CAV), an unusually accelerated and diffuse form of obliterative coronary arteriosclerosis, det ermines long-term function of the transplanted heart. Cardiac allograft vas culopathy is a complicated interplay between immunologic and nonimmunologic factors resulting in repetitive vascular injury and a localized sustained inflammatory response. Dyslipidemia, oxidant stress, immunosuppressive drug s, and viral infection appear to be important contributors to disease devel opment. Endothelial dysfunction is an early feature of CAV and progresses o ver time after transplantation Early identification of CAV is essential if long-term prognosis is to be improved. Annual coronary angiography is perfo rmed for diagnostic and surveillance purposes. Intravascular ultrasound is a more sensitive diagnostic fool for early disease stages and has revealed that progressive luminal narrowing in CAV is in part due to negative vascul ar remodeling. Because of the diffuse nature of CAV, percutaneous and surgi cal revascularization procedures have a limited rate. Prevention of CAV pro gression is a primary therapeutic goal. (C) 1000 Lippincott Williams & Wilk ins, Inc.