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Cardiac Allograft Vasculopathy (II)

Epicardial coronaries CAV in pediatric patientIn this close up of the pediatric heart shown before you can see the right and left coronary arteries as they travel through the atrioventricular sulcus. Their lumina are markedly narrowed by the proliferative intimal thickening in CAV. The intimal proliferation is well demonstrated on gross exam in these images and also upon light microscopic examination. If atherosclerotic plaques were present in the donor heart prior to the transplantation, the morphology of the lesion is one of eccentric atheromatous plaques with superimposed intimal proliferation of transplant-related vasculopathy.
Cardiac allograft vasculopathy can also involve the conduciton system of the heart, including the SA node and the AV node.
The artery to the AV node is shown in white rectangle in the upper image. This microscopic view demonstrats the artery of the AV node of an adult involved by CAV and virtual microscopy of the artery to the AV node artery and His bundle and one of its branches is shown here.
In addition to the epicardial coronary arteries, the intramural medium and small coronary arteries can be affected by CAV. This occurs usually as a later event than the involvement of the epicardial coronaries.


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