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Cardiac Allograft Vasculopathy

The most challenging problem in heart transplantation to achieve consistent long-term successful outcome is the development of cardiac allograft vasculopathy (CAV). Other names for this entity are: graft coronary artery disease, graft coronary vascular disease, transplant coronary artery disease, accelerated graft arteriosclerosis, and chronic rejection.

Cardiac allograft vasculopathy develops in a majority of transplanted hearts at a variable rate. In rare instance as early as 3 months after transplantation. According to the international society for heart and lung transplantation (ISHLT) only 47% of adults are free of CAV as detected by angiography at 9.5 years. In children, the incidence is lower compared with adults, with 75% of patients free of CAV at 7 years post transplant.

Allograft vasculopathy involves both epicardial and intramural coronary arteries. The classic feature of CAV is that of diffuse concentric narrowing with luminal stenosis. The images below show gross examination examples of allograft vasculopathy in a pediatric age heart. The epicardial coronaries are markedly thickened. Microscopic features of allograft vasculopathy are shown here.

CAV in a pediatric age patient

This coronal four chamber view of the heart shows the circumflex and the right coronary arteries. Close up of the area framed by the rectangle.

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