Coronary Magnetic Resonance Angiography in Heterotopic Heart Transplant Recipient

Coronary allograft vasculopathy remains the main limiting survival factor after heart transplantation and the major cause of mortality after the first year post-transplant, ultimately leading to graft loss.1 Coronary x-ray angiography is the clinical gold standard and the most widely used diagnostic technique for coronary allograft vasculopathy in the majority of transplant centers. However, repeated x-ray procedures have inherent risks related to the cumulative radiation dose. Coronary magnetic resonance angiography2 (CMRA) has emerged as a useful imaging modality in pediatric patients as a noninvasive and radiation-free approach and appears very promising for imaging the coronary arteries in heart transplant recipients, although it has yet to be clinically established.A 16-year-old girl who had received a heterotopic heart transplant (HHT) at 5 months of age because of an undersized graft attended our follow-up clinic. She had been diagnosed with dilated cardiomyopathy at 3.5 months of age. Heterotopic heart transplant can be used in rare cases in which orthotopic heart transplantation is contraindicated, such as for elevated pulmonary …