Premium
Epicardial and microvascular graft vessel disease in children
Author(s) -
Hiemann NE,
Wellnhofer E,
AbdulKhaliq H,
Hetzer R,
Meyer R
Publication year - 2004
Publication title -
acta pædiatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/j.1651-2227.2004.tb00242.x
Subject(s) - medicine , cardiology , heart transplantation , vascular disease , incidence (geometry) , limiting , transplantation , thickening , circulatory system , pathology , mechanical engineering , physics , optics , engineering , chemistry , polymer science
Aim : Graft vessel disease (GVD) is one of the main limiting factors to long‐term survival after adult heart transplantation (HTx). The incidence of epicardial and microvascular GVD in paediatric patients was studied. Methods : A total of 137 coronary angiographies from 130 paediatric HTx and heart and lung transplant (HLTx) patients (70 male, 60 female, aged 0–18 y) were evaluated according to the Stanford classification and its supplements (minor vessel alterations). In H&E stainings from right ventricular endomyocardial biopsies (EMB = 397), light microscopic diagnosis of acute cellular rejection (ISHLT classification) and vascular reaction (morphology of endothelial cells and vessel walls) was performed. Results : Moderate rejection was present in 32.8% and severe rejection in 13.3% of EMB. Microvascular EC swelling was found in 33.5% and vessel wall thickening in 53.8% of EMB. The results of the coronary angio‐graphic investigations were: Stanford lesions = 61.2%, peripheral obliterations = 52.5%, diameter fluctuations = 86.3%, pathologic tapering = 64.0%, calcifications = 10.8%. Long‐term survivors (≥5 y) showed macrovascular alterations in 78% of cases and microvascular alterations in 67% of cases. Conclusion : The development of micro‐ and macrovascular GVD is one of the predominant complications in long‐term survivors after paediatric HTx and HLTx.