Cardiac Allograft Vasculopathy Can Be Distinguished From Donor-Transmitted Coronary Atherosclerosis by Optical Coherence Tomography Imaging in a Heart Transplantation Recipient

Imamura, Teruhiko; Kinugawa, Koichiro; Murasawa, Takahide; Kagami, Yukie; Endo, Miyoko; Muraoka, Hironori; Fujino, Takeo; Inaba, Toshiro; Maki, Hisataka; Hatano, Masaru; Katoh, Osamu; Nawata, Kan; Kyo, Shunei; Komuro, Issei; Ōno, Minoru

doi:10.1536/ihj.13-279

Cited by 16 publications

(17 citation statements)

References 21 publications

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“…3) Moreover, OCT has a potential to clearly delineate inner intimal proliferation as layered intima by its high image resolu-tion, consistent with the present report. 22) Nevertheless, there are only limited data regarding OCT findings in post-KD patients, in which concentric/eccentric intimal thickening, calcification, disappearance of the media, white thrombus, neo-vascularization, and lipid deposition have been observed. 3,23,24) Thus, it is reasonable to propose that not only IVUS but also OFDI might be a useful imaging device, especially for PCI against complex lesions such as the coronary sequelae of KD.…”

Section: Discussionmentioning

confidence: 99%

Rotational Atherectomy Followed by Drug-Coated Balloon Dilation in Possible Coronary Sequelae of Kawasaki Disease

et al. 2016

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SummaryRotational atherectomy with/without low-pressure balloon dilation has been a mainstay of interventional treatment for stenosis due to the coronary sequelae of Kawasaki disease (KD). Here, we report a restenosis case of probable coronary sequelae of KD treated with rotational atherectomy with low-pressure 2.5-mm balloon dilation 6 months previously. Under the guidance of optical frequency domain imaging, we performed rotational atherectomy followed by 2.5-mm drug-coated balloon (DCB) dilation for an atherosclerotic restenosis at the inlet of a calcified aneurysm in the proximal left anterior descending coronary artery. Coronary angiography 6 months later showed no apparent progression of vessel narrowing, and we could defer repeat intervention. The present case suggests that rotational atherectomy followed by DCB dilation could be an alternative revascularization therapy of choice in coronary KD sequelae complicated with atherosclerosis. (Int Heart J 2016; 57: 367-371) Key words: Optical frequency domain imaging, Fractional flow reserve, Atherosclerosis, Dyslipidemia C oronary sequelae of Kawasaki disease (KD) has a variety of morphological manifestations, such as aneurysm, stenosis, and total occlusion concomitant with nonatherosclerotic intimal thickening and frequent severe calcification, while a few reports have demonstrated early atherosclerosis progression in young adults with prior KD.1-3) Since these stiff calcified lesions have risk of stent underexpansion and neo-aneurysmal formation ascribed to high-pressure balloon inflation, rotational atherectomy with/without additional low-pressure balloon dilation alone has been a mainstay of interventional treatment for stenosis due to the coronary sequelae of KD. [4][5][6] In contrast, drug-coated balloons (DCB) now play a central role in the treatment of in-stent restenosis through their inhibition of neointimal hyperplasia, despite the lack of evidence for de novo coronary artery disease. 7,8) We describe here our experience with an atherosclerotic-restenosis case of probable coronary sequelae of KD previously treated with rotational atherectomy with additional low-pressure balloon dilation 6 months before, 3) in which rotational atherectomy followed by DCB dilation could defer any subsequent repeat intervention. Case ReportAn asymptomatic 47 year-old male was admitted to our hospital to undergo 6-month follow-up coronary angiography (CAG). Six months previously, based on a diagnosis of silent myocardial ischemia due to possible sequelae of KD, we had performed rotational atherectomy with 1.5/2.0 mm burrs followed by low-pressure dilation using a balloon catheter 2.5/15 mm at 4 atm for a stenosis at the inlet of a calcified aneurysm in the proximal segment of the left anterior descending coronary artery (LAD) ( Figure 1A, 1B). Although he had no apparent history of KD, he was hospitalized for 40 days due to fever of unknown cause with systemic eruption at the age of 6 months. His coronary risk factor was dyslipidemia, and under medication consisting ...

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Section: Discussionmentioning

confidence: 99%

Rotational Atherectomy Followed by Drug-Coated Balloon Dilation in Possible Coronary Sequelae of Kawasaki Disease

et al. 2016

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“…These techniques have their limitations, however, particularly poor spatial resolution and an insufficient qualitative and quantitative assessment of the coronary artery intima. This is the reason why optical coherence tomography (OCT) has been recently introduced, a new intracoronary imaging technique using optical analog ultrasound with a space resolution of 10-20 μm, 10 times more than what ultrasound allows 15 . As already stated above, all patients were treated by immunosuppressive protocol consisting of a triple drug combination: cyclosporine A or tacrolimus, mycophenolate mofetil and steroids.…”

Section: Discussionmentioning

confidence: 99%

Monitoring of allograft vasculopathy by intravascular ultrasound one month and one year after heart transplantation: A single center study

Bedáňová¹,

Orban²,

Třetina³

et al. 2016

BIOMED PAP

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Aims. The aim of this trial was to use intravascular ultrasound (IVUS) to determine whether cardiac allograft vasculopathy (CAV) starts progressing during the first year after heart transplantation (HTx). Methods. We retrospectively analyzed 51 patients (11 women) who received heart transplants in our center between January 2010 and September 2013 and underwent coronary angiography as well as IVUS examination one month and one year after HTx. Patients with proven calcification and fibrotic plates in the IVUS examination one month after HTx constituted a group with defined donor-transmitted atherosclerosis (DTA). In patients without DTA, measurements of maximal intimal thickening (MIT) were made in two predetermined locations. Results. Eight of the 51 patients had DTA, while 43 did not. These were divided based on maximal intimal thickness (MIT) into a group with MIT < 0.5 mm (27) and MIT ≥ 0.5 mm (16). No patient with MIT < 0.5 mm developed allograft vasculopathy within one year after HTx. CAV developed in three patients (P = 0.045) out of the 16 patients with MIT ≥ 0.5. In patients with DTA, a statistically significant deterioration in percent area stenosis (PAS) occurred in both artery sections (P = 0.01). Conclusion. Our trial showed that CAV progresses during the first year after HTx significantly more frequently in patients with DTA and MIT ≥ 0.5 mm. It is essential in these patients to implement an IVUS control examination one year after transplantation. The results can lead to a change in treatment strategy to prevent further progress of the disease.

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“…The new immunosuppressant EVL, which is a mammalian target of rapamycin, has recently been demonstrated to have various advantages in terms of its prophylactic effect of CMV infection, 8,13) suppressive effect of cardiac allograft vasculopathy, [14][15][16] anti-malignancy effect, 17,18) and maintenance of renal function, 19) and subsequently its use has increased around the world. Although EVL has been reported to have a prophylactic effect towards PTLD, 18) it may not necessarily protect the development of early-PTLD completely considering the findings in the present patient.…”

Section: Discussionmentioning

confidence: 99%

How Should We Treat Early Post-Transplant Lymphoproliferative Disease After Heart Transplantation?

et al. 2015

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SummaryAlthough post-transplant lymphoproliferative disease (PTLD) is one of the major fatal complications encountered several years after heart transplant (HTx), little is known about early-PTLD emerging within the first year. We here describe the rare case of a 24-year-old female patient who suffered from early-PTLD (DLBCL: diffuse large B-cell lymphoma) associated with an Epstein-Barr virus (EBV) infection, that developed around the jejunum at 7 months after HTx. She suffered from acute abdominal peritonitis due to perforation of the jejunum soon after the first chemotherapy. She was treated successfully by emergent partial resection of the jejunum and colostomy after the discontinuation of everolimus (EVL) and successive low-dose chemotherapy under careful monitoring and adjustment of intravenous immunosuppressant including cyclosporine (CyA) and prednisolone to avoid a rejection reaction. Prophylactic strategies for early-PTLD in HTx recipients should be undertaken with caution. (Int Heart J 2015; 56: 676-678)

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Cardiac Allograft Vasculopathy Can Be Distinguished From Donor-Transmitted Coronary Atherosclerosis by Optical Coherence Tomography Imaging in a Heart Transplantation Recipient

Cited by 16 publications

References 21 publications

Rotational Atherectomy Followed by Drug-Coated Balloon Dilation in Possible Coronary Sequelae of Kawasaki Disease

Rotational Atherectomy Followed by Drug-Coated Balloon Dilation in Possible Coronary Sequelae of Kawasaki Disease

Monitoring of allograft vasculopathy by intravascular ultrasound one month and one year after heart transplantation: A single center study

How Should We Treat Early Post-Transplant Lymphoproliferative Disease After Heart Transplantation?

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