Cardiac Allograft Vasculopathy Evaluation by Optical Coherence Tomography

Cardiac allograft vasculopathy (CAV) is a rapidly progressive form of atherosclerosis and it is the common cause of late allograft dysfunction and death in patients following orthotopic heart transplantation. After heart transplantation, patients lack adequate anginal mechanisms and may present with refractory heart failure and sudden cardiac death, so regular screening is required to detect CAV. CAV narrows the coronary arteries in diffuse concentric pattern, so detection by coronary angiogram is difficult. Intravascular imaging such as optical coherence tomography (OCT) and intravascular ultrasound is most sensitive diagnostic test for the detection of CAV. Once CAV is diagnosed, patients should be on statins, adequate immunosuppressive medications such as sirolimus, everolimus in focal lesions angioplasty, and stenting can be done, but in some patients with significant burden of CAV, retransplantation is the only available option. Once CAV is diagnosed, regular surveillance of heart function is mandatory. We are reporting a case of CAV evaluation by OCT.