Coronary Ectasia in Pediatric Heart Transplant Recipients

Graft vasculopathy (GV) is a late complication of heart transplantation (HT) often resulting in graft loss. In adult HT recipients, the spectrum of GV lesions ranges from vessel narrowing (pruning) to stenosis and/or occlusion. Surveillance angiography (angio) in our pediatric patients (ped pts) revealed a subgroup with coronary ectasia (CE), significant dilation of one or more coronary arteries without stenosis. Our aim is to describe this unique subgroup of CE pts and compare risk factors and outcomes to pts with stenotic GV. All ped pts transplanted from 1986-2002 with angio evidence of GV were studied. CE was defined as vessel diameter >1.3 times the normal adjacent area with no evidence of stenosis. GV pts with CE were compared to those without CE. Angio GV occurred in 26/174 pts (15%) at a mean of 4.4±2.8 yrs (range1-9) post HT. Mean age at HT was 8.9±5.4 yrs and mean age at GV diagnosis was 13.5±5.8 yrs (range1-24). Mean donor age was 13±10.6 yrs (range 1-39). Overall mean survival of GV pts was 7.7±3.5 yrs (range 1-13). At GV presentation, CE occurred in 7 pts (27%), stenosis in 17 pts (65%), and significant pruning in 2 pts. Pt survival post diagnosis of GV was 3.3±1.8 yrs. Comparison including length of followup, noncompliance, rejection with hemodynamic compromise (RHDC), and CMV serology, in pts with and without ectasia revealed: Tabled 1 #Pts Yrs f/u Died Noncompliant RHDC Donor CMV ReHT CE 7 4.9 ± 3.9 0 0 0 6 (86%) 3 no CE 19 6.1 ± 2.9 11 12 10 6 (32%) 5 p value .37 .01 .01 .02 .03 .64 Open table in a new tab