Abstract 12712: Optical Coherence Tomography Identifies Coronary Artery Abnormalities in Children
Introduction: Optical Coherence Tomography (OCT) is a high-resolution intravascular imaging technique (resolution ~ 10 microns) used in adults. Presently the evaluation of coronary pathology in children relies on conventional angiography. We assessed the hypothesis that OCT could identify coronary abnormalities not seen by angiography in children with a history of Kawasaki Disease (KD) and pediatric transplant (Tx) recipients.
Methods: KD patients and Tx recipients were evaluated at routine cardiac catheterization between December 2012 and June 2013 with selective coronary angiography and OCT (Ilumien System, LightLabs, St Jude Medical, Westford, MA). Modifications were made to the traditional OCT protocol used in adults to adapt this technique for children. Serial measurements of the cross sectional area (CSA) of the lumen, intima and media were made along the length of the vessel. Entire imaging data was analyzed for the presence of mural thrombus, plaque and calcification.
Results: Ten children were evaluated (3 KD patients; 7 Tx recipients). In KD patients selective coronary angiography was normal. The measured lumen area by OCT was normal (z-score >-2 and ≤+2) at 93% of the 61 data collection points. However, significant vessel wall abnormalities were present in all children including marked intimal thickening (intima/lumen CSA ratio > 1), white thrombus and calcification (Figure 1). There was extensive destruction of the internal elastic lamina. In Tx recipients selective coronary angiography was normal, however intimal thickening [intima/media (I/M) CSA ratio >1] was seen in 6/7 patients (Figure 1). The median I/M CSA ratio was 1.25.
Conclusion: In this initial experience with OCT in children, we have shown that there are significant abnormalities in the coronary arteries of children with a history of KD and in pediatric transplant recipients that are not identified with conventional angiography.
- © 2013 by American Heart Association, Inc.