ABSTRACT
Heart transplantation remains the definitive therapy for patients with advanced congestive heart failure. This chapter reviews the importance of screening and the pathophysiology of cardiac allograft vasculopathy (CAV), and explores the utilization of optical coherence tomography (OCT) as a novel and ideal imaging tool for this disease process. Screening and diagnosing CAV presents a difficult clinical dilemma since most patients with CAV are asymptomatic due to cardiac sensory denervation resulting from the transplant surgery. OCT allows for accurate high-resolution quantitative imaging of the coronary arteries and characterization of intimal hyperplasia and atherosclerotic plaques. OCT imaging has allowed for in vivo assessment of findings previously noted only on autopsy studies and has extended our understanding of CAV beyond just intimal hyperplasia to also involving complex atherosclerotic plaques. Revascularization with stenting or bypass surgery remains an option for patients with focal disease, and retransplantation remains the only definitive treatment for advanced CAV with graft dysfunction.
