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Sun L, Jiang Q, Xie Y, Wang S, Zhang Z. Optical coherence tomography of the pulmonary arteries in children with congenital heart diseases: A systematic review. Pediatr Investig 2022; 6:264-270. [PMID: 36582270 PMCID: PMC9789933 DOI: 10.1002/ped4.12353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 10/14/2022] [Indexed: 12/05/2022] Open
Abstract
Importance Optical coherence tomography (OCT) is a high-resolution intravascular imaging tool and has shown promise for providing real-time quantitative and qualitative descriptions of pulmonary vascular structures in vivo in adult pulmonary hypertension (PH), while not popular in pediatric patients with congenital heart diseases (CHD). Objective The aim of this review is to summarize all the available evidence on the use of OCT for imaging pulmonary vascular remodeling in pediatric patients. Methods We conducted the systematic literature resources (Cochran Library database, Medline via PubMed, EMBASE, and Web of Knowledge) from January 2010 to December 2021 and the search terms were "PH", "child", "children", "pediatric", "OCT", "CHD", "pulmonary vessels", "pulmonary artery wall". Studies in which OCT was used to image the pulmonary vessels in pediatric patients with CHD were considered for inclusion. Results Five studies met the inclusion criteria. These five papers discussed the study of OCT in the pulmonary vasculature of different types of CHD, including common simple CHD, complex cyanotic CHD, and Williams-Beuren syndrome. In biventricular anatomy, pulmonary vascular remodeling was primarily reflected by pulmonary intima thickening from two-dimensional OCT. In single-ventricle anatomy, due to the state of hypoxia, the morphology of pulmonary vessels was indirectly reflected by the number and shape of nourishing vessels from three-dimensional OCT. Interpretation OCT may be an adequate imaging procedure for the demonstration of pulmonary vascular structures and provide additional information in pediatric patients.
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Affiliation(s)
- Ling Sun
- Department of Pediatric CardiologyGuangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangdong Cardiovascular InstituteGuangdong Provincial Key Laboratory of South China Structural Heart DiseaseGuangzhouGuangdongChina
| | - Qiuping Jiang
- Department of Pediatric CardiologyGuangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangdong Cardiovascular InstituteGuangdong Provincial Key Laboratory of South China Structural Heart DiseaseGuangzhouGuangdongChina
| | - Yumei Xie
- Department of Pediatric CardiologyGuangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangdong Cardiovascular InstituteGuangdong Provincial Key Laboratory of South China Structural Heart DiseaseGuangzhouGuangdongChina
| | - Shushui Wang
- Department of Pediatric CardiologyGuangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangdong Cardiovascular InstituteGuangdong Provincial Key Laboratory of South China Structural Heart DiseaseGuangzhouGuangdongChina
| | - Zhiwei Zhang
- Department of Pediatric CardiologyGuangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangdong Cardiovascular InstituteGuangdong Provincial Key Laboratory of South China Structural Heart DiseaseGuangzhouGuangdongChina
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2
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Deep Learning-Based Approach to Automatically Assess Coronary Distensibility Following Kawasaki Disease. Pediatr Cardiol 2022; 43:807-815. [PMID: 34854943 DOI: 10.1007/s00246-021-02790-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/20/2021] [Indexed: 10/19/2022]
Abstract
Kawasaki disease is an acute vasculitis affecting children, which can lead to coronary artery (CA) aneurysms. Optical coherence tomography (OCT) has identified CA wall damage in KD patients, but it is unclear if these findings correlate with any distensibility changes in the CA and how these changes evolve over time. This paper seeks to establish the link between OCT findings and vessel distensibility with a novel deep learning coronary artery segmentation system and use the segmentation framework to automatically analyze the temporal evolution of coronary stiffness over many years. 27 KD patients underwent catheterization with coronary angiography of the left coronary artery (LCA), followed by OCT of proximal and distal segments of the LCA. Changes in the CA caliber over the cardiac cycle were measured automatically and compared against OCT findings suggestive of KD-related vascular damage. In addition, 34 KD patients with regressed or persistent CA aneurysms were followed with serial CA angiography over an average of 14.5 years. Distensibility changes were calculated using a deep learning coronary artery segmentation framework and evaluated longitudinally. Distensibility in the coronary arteries after KD negatively correlated with increasing severity of OCT findings of KD-related vessel damage. KD patients have a significant increase in CA wall stiffness at 1 year after diagnosis, which then plateaus subsequently, compared to controls. Also, patients with persistent CA aneurysms have a statistically significant increase in wall stiffness over time in comparison to those with regressed CA aneurysms. Distensibility changes in the CA of KD patients calculated using our automated deep learning approach correlates with the severity of OCT findings of KD-related CA damage. This decreased distensibility peaks at 1 year in KD patients when following longitudinally and is more severe in those with persistent CA aneurysms.
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3
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Shiraki T, Ichibori Y, Ohtani T, Mizote I, Kioka H, Tsukamoto Y, Nakamura D, Yokoi K, Ide S, Nakamoto K, Takeda Y, Kotani JI, Hikoso S, Sawa Y, Sakata Y. Pathophysiological Evaluations of Initial Plaque Development After Heart Transplantation via Serial Multimodality Imaging and Cytokine Assessments. J Heart Lung Transplant 2022; 41:877-885. [DOI: 10.1016/j.healun.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 02/14/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022] Open
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4
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Laguë SL, Bone JN, Samuel R, Voss C, Balbacid E, Hosking MCK, Schubert S, Harris KC. Patterns of Early Coronary Artery Changes in Pediatric Heart Transplant Recipients Detected Using Optical Coherence Tomography. Circ Cardiovasc Imaging 2022; 15:e012486. [PMID: 35041446 DOI: 10.1161/circimaging.121.012486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiac allograft vasculopathy, the leading cause of graft failure in pediatric heart transplant recipients, is characterized by diffuse and concentric coronary intimal thickening. Early treatment yields better outcomes. While coronary angiography is the standard for cardiac allograft vasculopathy screening and diagnosis, it only identifies luminal narrowing, which occurs in more severe disease. Coronary optical coherence tomography (OCT) is a high-definition intravascular imaging modality that may offer earlier diagnosis. We used OCT to investigate coronary intimal thickening in pediatric transplant recipients and examined its (1) location (ie, vessel type and location) and (2) nature (ie, characteristics of cross-sectional and longitudinal thickening). METHODS Sites collected coronary angiography and OCT data from participants (N=258 vessel segments from 73 individuals; median age: 11.5 years [8.4-15.3]; 55% male). Images were collected from the left anterior descending, left circumflex, and right coronary arteries, and location (ie, proximal, middle, and distal) were classified using coronary angiography. RESULTS OCT identified 32 vessel segments meeting criteria for significant thickening, 88% of which were angiographically silent. Longitudinal thickening was segmental rather than global in 88%, and cross-sectional thickening was 48% eccentric and 52% concentric. Intimal thickening prevalence and severity measures did not consistently differ between coronary artery type (P=1.000) or location (P=0.248) but increased with time since transplant and age at transplant and OCT procedure. CONCLUSIONS In pediatric transplant recipients, we observed a surprisingly high prevalence of segmental and eccentric intimal thickening. Insights from intravascular imaging suggest these patterns of coronary vascular changes may precede overt cardiac allograft vasculopathy. Identifying early changes may offer opportunity for enhanced surveillance and earlier intervention.
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Affiliation(s)
- Sabine L Laguë
- Department of Pediatrics, University of British Columbia, Vancouver, Canada (S.L.L.).,Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, Canada (S.L.L., R.S., C.V., M.C.K.H., K.C.H.)
| | - Jeffrey N Bone
- British Columbia Children's Hospital Research Institute, Vancouver, Canada (J.N.B., E.B.)
| | - Rosh Samuel
- Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, Canada (S.L.L., R.S., C.V., M.C.K.H., K.C.H.)
| | - Christine Voss
- Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, Canada (S.L.L., R.S., C.V., M.C.K.H., K.C.H.)
| | - Enrique Balbacid
- British Columbia Children's Hospital Research Institute, Vancouver, Canada (J.N.B., E.B.)
| | - Martin C K Hosking
- Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, Canada (S.L.L., R.S., C.V., M.C.K.H., K.C.H.)
| | - Stephan Schubert
- Pediatric Cardiology Department, La Paz Children's University Hospital, Madrid, Spain (S.S.).,German Heart Center Berlin, Department of Congenital Heart Disease - Pediatric Cardiology, Berlin, Germany (S.S.).,Center for Congenital Heart Disease/Pediatric Cardiology, Heart, and Diabetes Center NRW, University Clinic of Ruhr-University Bochum, Germany (S.S.).,Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany (S.S.)
| | - Kevin C Harris
- Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, Canada (S.L.L., R.S., C.V., M.C.K.H., K.C.H.)
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5
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Mao R, Coe JY, Minhas K, Florescu O, Tymchak W, Schantz D, Buffo I, Soni R, Hyman J, Pepelassis D. OCT: A Modality for Identifying Stent Failure in Pediatric Patients With Angiographically Silent Coronary Arteries. JACC Case Rep 2021; 3:849-852. [PMID: 34317640 PMCID: PMC8311378 DOI: 10.1016/j.jaccas.2021.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Abstract
We present the case of a 16-year-old patient with anomalous left coronary artery from the left pulmonary artery requiring percutaneous coronary intervention in infancy who presented with ventricular fibrillation arrest. A coronary angiogram revealed 40% narrowing of the stent relative to the remainder of the left main coronary artery. Optical coherence tomography was performed and revealed an area stenosis of 70% relative to the native left main coronary artery. The patient had outgrown the stent. (Level of Difficulty: Advanced.)
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Key Words
- ACE, angiotensin-converting enzyme
- ALCAPA
- ALCAPA, with anomalous left coronary artery from the left pulmonary artery
- CMR, cardiac magnetic resonance
- DES, drug-eluting stent
- ECG, electrocardiogram
- LMCA, left main coronary artery
- LV, left ventricular
- MLA, minimum lumen area
- OCT
- OCT, optical coherence tomography
- PCI
- PCI, percutaneous coronary intervention
- TTE, transthoracic echocardiography
- long-term survival
- outgrown stent
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Affiliation(s)
- Ruochen Mao
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - James-Yashu Coe
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Kunal Minhas
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Oana Florescu
- Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Wayne Tymchak
- Section of Cardiology, Department of Internal Medicine, University of Alberta, Edmonton, Canada
| | - Daryl Schantz
- Department of Pediatrics, University of Manitoba, Winnipeg, Canada.,Variety Children's Heart Centre, Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Ilan Buffo
- Department of Pediatrics, University of Manitoba, Winnipeg, Canada.,Variety Children's Heart Centre, Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Reeni Soni
- Department of Pediatrics, University of Manitoba, Winnipeg, Canada.,Variety Children's Heart Centre, Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Jeff Hyman
- Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Dionysios Pepelassis
- Department of Pediatrics, University of Manitoba, Winnipeg, Canada.,Variety Children's Heart Centre, Department of Pediatrics, University of Manitoba, Winnipeg, Canada
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6
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McGovern E, Hosking MC, Balbacid E, Voss C, Berger F, Schubert S, Harris KC. Optical Coherence Tomography for the Early Detection of Coronary Vascular Changes in Children and Adolescents After Cardiac Transplantation. JACC Cardiovasc Imaging 2019; 12:2492-2501. [DOI: 10.1016/j.jcmg.2018.04.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/22/2018] [Accepted: 04/26/2018] [Indexed: 11/28/2022]
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7
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Abdolmanafi A, Duong L, Dahdah N, Cheriet F. Intra-Slice Motion Correction of Intravascular OCT Images Using Deep Features. IEEE J Biomed Health Inform 2019; 23:931-941. [DOI: 10.1109/jbhi.2018.2878914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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8
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Pulmonary artery wall thickness in children with Fontan physiology: an optical coherence tomography case control study. Cardiol Young 2019; 29:524-527. [PMID: 30957731 DOI: 10.1017/s1047951119000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Failure of the Fontan circulation is not a well-understood clinical phenomena.For some patients, a gradual increase in pulmonary vascular resistance (PVR) and structural changes in the pulmonary artery may be an important causative factor. To further investigate this issue, we employed optical coherence tomography (OCT) to evaluate structural changes within the pulmonary arteries of Fontan patients and compared to those with a normal pulmonary circulation. MATERIALS AND METHODS Pulmonary artery OCT was performed, without complications, in 12 Fontan and 11 control patients. Wall thickness and wall:vessel cross-sectional area (CSA) ratio were calculated after image acquisition, using digital planimetry. RESULTS There was no difference in wall thickness between both groups. Median wall thickness for Fontan patients was 0.12 mm (IQR, 0.10-0.14) and for controls was 0.11 mm (IQR, 0.10-0.12; p = 0.62). Wall:vessel CSA ratio for Fontan patients was 0.13 (IQR, 0.12-0.16) and for controls was 0.13 (IQR, 0.11-0.15) (p = 0.73). There was no association between wall thickness and ventricle morphology, age at catheterisation, age at Fontan, years since Fontan completion, pulmonary artery pressure, and PVR. The vessel media was more readily visualised in control patients. DISCUSSION OCT of the pulmonary arteries in Fontan patients is safe and feasible. Our OCT findings suggest that during childhood, pulmonary artery wall dimensions are normal in Fontan children with reassuring hemodynamics. Further evaluation of Fontan patients with abnormal hemodynamics and serial evaluation into adulthood are required to conclude on the utility of OCT for identifying early pulmonary artery structural changes.
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9
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Cote AT, Hosking M, Voss C, Human DG, Sandor GGS, Harris KC. Coronary artery intimal thickening and ventricular dynamics in pediatric heart transplant recipients. CONGENIT HEART DIS 2018; 13:663-670. [DOI: 10.1111/chd.12629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/18/2018] [Accepted: 05/21/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Anita T. Cote
- Department of Pediatrics; University of British Columbia & British Columbia Children’s Hospital Research Institute; Vancouver Canada
- School of Human Kinetics; Trinity Western University; Langley Canada
| | - Martin Hosking
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
| | - Christine Voss
- Department of Pediatrics; University of British Columbia & British Columbia Children’s Hospital Research Institute; Vancouver Canada
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
| | - Derek G Human
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
| | - George G. S. Sandor
- Department of Pediatrics; University of British Columbia & British Columbia Children’s Hospital Research Institute; Vancouver Canada
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
| | - Kevin C. Harris
- Department of Pediatrics; University of British Columbia & British Columbia Children’s Hospital Research Institute; Vancouver Canada
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
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10
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McCrindle BW, Harris KC. Coronary Artery Aneurysms After Kawasaki Disease: Understanding the Pathology. Can J Cardiol 2018; 34:1094-1097. [DOI: 10.1016/j.cjca.2018.07.412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 11/24/2022] Open
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11
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Dionne A, Ibrahim R, Gebhard C, Benovoy M, Leye M, Déry J, Lapierre C, Girard P, Fournier A, Dahdah N. Difference Between Persistent Aneurysm, Regressed Aneurysm, and Coronary Dilation in Kawasaki Disease: An Optical Coherence Tomography Study. Can J Cardiol 2018; 34:1120-1128. [PMID: 30093299 DOI: 10.1016/j.cjca.2018.05.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Coronary artery (CA) aneurysms are a serious complication of Kawasaki disease (KD). Conventional imaging techniques often described segments with regressed aneurysms as normal, whereas studies have shown significant endothelial dysfunction. METHODS KD patients with aneurysms scheduled for routine coronary angiography underwent optical coherence tomography (OCT) imaging between 2013 and 2016. Microstructural coronary changes were compared between normal CA segments and those with dilation, regressed aneurysms, and persistent aneurysms. RESULTS OCT was performed on 33 patients aged 12.0 ± 5.4 years, 8.5 ± 5.4 years after KD diagnosis. Of the 79 segments analyzed, 25 had persistent aneurysms, 22 regressed aneurysms, 11 CA dilation, and 21 no CA involvement. Intimal thickness was 489 ± 173 μm, 304 ± 158 μm, 102 ± 68 μm, and 63 ± 29 μm, respectively (P < 0.001). There was a linear correlation between the maximum aneurysm size and the intimal thickness, as well as coronary dimension at the time of OCT. Fibrosis (54 segments, 68%) and cellular infiltration (22 segments, 28%) were found more often in segments with CA involvement, but also those without (P = 0.01; P = 0.02). Destruction of the media (34 segments, 43%), calcifications (6 segments, 8%), neovascularization (18 segments, 23%), and white thrombi (8 segments, 10%) were found almost exclusively in segments with a history of aneurysms. CONCLUSIONS Intimal hyperplasia, fibrosis, and cellular infiltration were found in all categories of CA involvement, whereas calcification, destruction of the media, neovascularization, and white thrombi were found essentially only in segments with saccular or fusiform aneurysms. Prospective studies with outcome correlations are needed to see if this is associated with an increased risk of late adverse events.
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Affiliation(s)
- Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA; Division of Pediatric Cardiology, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Ragui Ibrahim
- Division of Cardiology, Pierre Boucher Hospital, Longueuil, Quebec, Canada
| | - Catherine Gebhard
- Center for Molecular Cardiology, University of Zurich, and Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Mitchel Benovoy
- Division of Applied Sciences, Corstem Inc. Montreal, Quebec, Canada
| | - Mohamed Leye
- Division of Pediatric Cardiology, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Julie Déry
- Division of Radiology, CHU Ste-Justine, Montreal, Quebec, Canada
| | | | - Patrice Girard
- Division of Pediatric Cardiology, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Sainte-Justine, Montreal, Quebec, Canada.
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12
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Duncombe SL, Hosking MCK, Coté AT, Voss C, Harris KC. Intimal thickening at coronary bifurcations in pediatric heart transplant recipients. Pediatr Transplant 2018; 22. [PMID: 29266632 DOI: 10.1111/petr.13100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2017] [Indexed: 11/30/2022]
Abstract
Heart transplant recipients are at increased risk for atherosclerosis and cardiac allograft vasculopathy, both initially presenting as intimal thickening. We aimed to determine the presence, extent, and anatomical characteristics of intimal thickness at coronary bifurcations in children using OCT. We measured the intimal thickness of coronary arteries in pediatric transplant recipients using OCT during routine cardiac catheterization. Intimal thickening was defined as (i) a percent change in contralateral intimal thickness greater than 50% when comparing the thickness at the bifurcation to the baseline thickness, and (ii) greater than 0.1 mm. We evaluated 153 unique coronary bifurcations in 31 children (58% boys, median 12.7 years). Intimal thickening was almost exclusively observed in the left coronary system (22 of 67 bifurcations) and rare in the right coronary system (2 of 86 bifurcations; P < .001). There was a positive association between the relative size of the side branch and contralateral intimal thickening at coronary bifurcations (P = .009). Intimal thickening at coronary bifurcations is already present in the left coronary system in many pediatric transplant recipients. The correlation between intimal thickening and side branch size suggests that low shear stress and oscillating shear stress may have an important role in the development of intimal thickening at coronary bifurcations.
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Affiliation(s)
- Stephanie L Duncombe
- Children's Heart Centre, BC Children's Hospital, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Martin C K Hosking
- Children's Heart Centre, BC Children's Hospital, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Anita T Coté
- School of Human Kinetics, Trinity Western University, Langley, BC, Canada
| | - Christine Voss
- Children's Heart Centre, BC Children's Hospital, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Kevin C Harris
- Children's Heart Centre, BC Children's Hospital, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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13
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Qureshi AM, Agrawal H. Catheter-based anatomic and functional assessment of coronary arteries in anomalous aortic origin of a coronary artery, myocardial bridges and Kawasaki disease. CONGENIT HEART DIS 2017; 12:615-618. [PMID: 28608519 DOI: 10.1111/chd.12500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/20/2017] [Indexed: 11/28/2022]
Abstract
Most diagnostic testing in patients with anomalous aortic origins of coronary arteries, myocardial bridges, and coronary artery changes after Kawasaki disease are performed with the use of noninvasive techniques. In some cases, however, further diagnostic information is needed to guide the clinician in treating these patients. In such instances, cardiac catheterization with invasive anatomic and functional testing is an invaluable tool. Moreover, interventional treatment in the cardiac catheterization laboratory may be performed in a small subset of these patients. As the diagnosis of these conditions is now becoming more common, it is important for pediatric interventional cardiologists to be familiar with these techniques. In this article, the role of angiography, intravascular ultrasound, fractional flow reserve, and optical coherence tomography in these patients is reviewed.
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Affiliation(s)
- Athar M Qureshi
- CE Mullins Cardiac Catheterization Laboratories, Houston, Texas, USA.,Coronary Anomalies Program and Division of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Hitesh Agrawal
- Coronary Anomalies Program and Division of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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14
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McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, Baker AL, Jackson MA, Takahashi M, Shah PB, Kobayashi T, Wu MH, Saji TT, Pahl E. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation 2017; 135:e927-e999. [PMID: 28356445 DOI: 10.1161/cir.0000000000000484] [Citation(s) in RCA: 2077] [Impact Index Per Article: 296.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and long-term outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances.
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15
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Ulrich SM, Lehner A, Birnbaum J, Heckel S, Haas NA, Hakami L, Schramm R, Dalla Pozza R, Fischer M, Kozlik-Feldmann R. Safety of optical coherence tomography in pediatric heart transplant patients. Int J Cardiol 2017; 228:205-208. [DOI: 10.1016/j.ijcard.2016.11.109] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 11/06/2016] [Indexed: 11/24/2022]
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16
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Gordon JB, Daniels LB, Kahn AM, Jimenez-Fernandez S, Vejar M, Numano F, Burns JC. The Spectrum of Cardiovascular Lesions Requiring Intervention in Adults After Kawasaki Disease. JACC Cardiovasc Interv 2016; 9:687-96. [DOI: 10.1016/j.jcin.2015.12.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 11/24/2015] [Accepted: 12/03/2015] [Indexed: 10/22/2022]
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17
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Shiraishi J, Matsubara Y, Yanagiuchi T, Shikuma A, Shoji K, Nishikawa M, Ito D, Kimura M, Kishita E, Nakagawa Y, Hyogo M, Sawada T, Kohno Y. Rotational Atherectomy Followed by Drug-Coated Balloon Dilation in Possible Coronary Sequelae of Kawasaki Disease. Int Heart J 2016; 57:367-71. [DOI: 10.1536/ihj.15-354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Jun Shiraishi
- Department of Cardiology, Kyoto First Red Cross Hospital
| | - Yuki Matsubara
- Department of Cardiology, Kyoto First Red Cross Hospital
| | | | - Akira Shikuma
- Department of Cardiology, Kyoto First Red Cross Hospital
| | - Keisuke Shoji
- Department of Cardiology, Kyoto First Red Cross Hospital
| | | | - Daisuke Ito
- Department of Cardiology, Kyoto First Red Cross Hospital
| | | | - Eigo Kishita
- Department of Cardiology, Kyoto First Red Cross Hospital
| | | | - Masayuki Hyogo
- Department of Cardiology, Kyoto First Red Cross Hospital
| | | | - Yoshio Kohno
- Department of Cardiology, Kyoto First Red Cross Hospital
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Dionne A, Kokta V, Chami R, Morissette G, Dahdah N. Fatal Kawasaki disease with incomplete criteria: Correlation between optical coherence tomography and pathology. Pediatr Int 2015; 57:1174-8. [PMID: 26711918 DOI: 10.1111/ped.12719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 04/01/2015] [Accepted: 04/13/2015] [Indexed: 11/29/2022]
Abstract
Coronary artery aneurysm is a serious complication of Kawasaki disease (KD). A 3-month-old infant presented with severe KD 27 days after onset of fever. The patient presented with shock, inferolateral ischemia on electrocardiogram and high troponin. Echocardiography showed severe myocardial dysfunction with diffuse coronary dilation and right coronary artery aneurysm. Arterial Doppler demonstrated thrombosis of aneurysmal axillary and iliac arteries. Withdrawal of support was implemented due to multi-organ failure. Post-mortem optical coherence tomography correlated with pathology. The pulmonary artery was normal on OCT and histology. Coronary arteries showed aneurysmal dilatation, with intimal hyperplasia and preserved media on OCT. Pathology confirmed these findings, with destruction of the internal elastic lamina, luminal myofibroblastic proliferation, neovascularization, and partial disappearance of the media. This is the first report of pathologic correlation in KD with OCT at the subacute stage, which adequately identified structural wall changes.
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Affiliation(s)
- Audrey Dionne
- Division of Pediatric Cardiology, CHU Saint Justine, Montreal, Canada
| | - Victor Kokta
- Division of Pathology, CHU Saint Justine, Montreal, Canada
| | - Rose Chami
- Division of Pathology, CHU Saint Justine, Montreal, Canada
| | | | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Saint Justine, Montreal, Canada
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19
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Dionne A, Ibrahim R, Gebhard C, Bakloul M, Selly JB, Leye M, Déry J, Lapierre C, Girard P, Fournier A, Dahdah N. Coronary Wall Structural Changes in Patients With Kawasaki Disease: New Insights From Optical Coherence Tomography (OCT). J Am Heart Assoc 2015; 4:e001939. [PMID: 25991013 PMCID: PMC4599424 DOI: 10.1161/jaha.115.001939] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/01/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Coronary artery aneurysms (CAA) are serious complications of Kawasaki disease (KD). Optical coherence tomography (OCT) is a high-resolution intracoronary imaging modality that characterizes coronary artery wall structure. The purpose of this work was to describe CAA wall sequelae after KD. METHODS AND RESULTS KD patients scheduled for routine coronary angiography underwent OCT imaging between March 2013 and August 2014. Subjects' clinical courses, echocardiography, and coronary angiography examinations were reviewed retrospectively. OCT was performed in 18 patients aged 12.4±5.5 years, 9.0±5.1 years following onset of KD. Of those, 14 patients (77.7%) had a history of CAA (7 with giant CAA and 7 with regressed CAA at time of OCT). Intracoronary nitroglycerin was given to all patients (88.4±45.5 μg/m(2)). Mean radiation dose was 10.9±5.2 mGy/kg. One patient suffered from a transitory uneventful vasospasm at the site of a regressed CAA; otherwise no major procedural complications occurred. The most frequent abnormality observed on OCT was intimal hyperplasia (15 patients, 83.3%) seen at both aneurysmal sites and angiographically normal segments amounting to 390.8±166.0 μm for affected segments compared to 61.7±17 μm for unaffected segments (P<0.001). Disappearance of the media, and presence of fibrosis, calcifications, macrophage accumulation, neovascularization, and white thrombi were seen in 72.2%, 77.8%, 27.8%, 44.4%, and 33.3% of patients. CONCLUSIONS In this study, OCT proved safe and insightful in the setting of KD, with the potential to add diagnostic value in the assessment of coronary abnormalities in KD. The depicted coronary structural changes correspond to histological findings previously described in KD.
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Affiliation(s)
- Audrey Dionne
- Division of Pediatric Cardiology, CHU Sainte-JustineMontreal, Quebec, Canada (A.D., R.I., M.B., J.-B.S., M.L., P.G.,
A.F., N.D.)
| | - Ragui Ibrahim
- Division of Pediatric Cardiology, CHU Sainte-JustineMontreal, Quebec, Canada (A.D., R.I., M.B., J.-B.S., M.L., P.G.,
A.F., N.D.)
- Division of Cardiology, Pierre Boucher HospitalLongueuil, Quebec, Canada (R.I.)
| | - Catherine Gebhard
- Division of Cardiology, Montreal Heart InstituteMontreal, Quebec, Canada (C.G.)
| | - Mohamed Bakloul
- Division of Pediatric Cardiology, CHU Sainte-JustineMontreal, Quebec, Canada (A.D., R.I., M.B., J.-B.S., M.L., P.G.,
A.F., N.D.)
- Division of Pediatric Cardiology, Louis Pradel HospitalLyon, France (M.B.)
| | - Jean-Bernard Selly
- Division of Pediatric Cardiology, CHU Sainte-JustineMontreal, Quebec, Canada (A.D., R.I., M.B., J.-B.S., M.L., P.G.,
A.F., N.D.)
- Division of Pediatric Cardiology, CHU BordeauxPessac, France (J.-B.S.)
| | - Mohamed Leye
- Division of Pediatric Cardiology, CHU Sainte-JustineMontreal, Quebec, Canada (A.D., R.I., M.B., J.-B.S., M.L., P.G.,
A.F., N.D.)
| | - Julie Déry
- Division of Radiology, CHU Ste-JustineMontreal, Quebec, Canada (J.D., C.L.)
| | - Chantale Lapierre
- Division of Radiology, CHU Ste-JustineMontreal, Quebec, Canada (J.D., C.L.)
| | - Patrice Girard
- Division of Pediatric Cardiology, CHU Sainte-JustineMontreal, Quebec, Canada (A.D., R.I., M.B., J.-B.S., M.L., P.G.,
A.F., N.D.)
| | - Anne Fournier
- Division of Pediatric Cardiology, CHU Sainte-JustineMontreal, Quebec, Canada (A.D., R.I., M.B., J.-B.S., M.L., P.G.,
A.F., N.D.)
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Sainte-JustineMontreal, Quebec, Canada (A.D., R.I., M.B., J.-B.S., M.L., P.G.,
A.F., N.D.)
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Shiraishi J, Yashige M, Hyogo M, Shima T, Sawada T, Kohno Y. Lipid-rich plaque in possible coronary sequelae of Kawasaki disease detected by optical frequency domain imaging. Cardiovasc Interv Ther 2014; 30:367-71. [DOI: 10.1007/s12928-014-0305-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/18/2014] [Indexed: 11/24/2022]
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21
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Greenway SC, Hosking M, Harris KC. Optical coherence tomography for the evaluation of asymmetric cardiac allograft vasculopathy in a child. Pediatr Transplant 2014; 18:E190-2. [PMID: 24953969 DOI: 10.1111/petr.12303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2014] [Indexed: 11/30/2022]
Abstract
We present an unusual case of CAV in a child with isolated disease in the LAD coronary artery. Initial progression of the disease appeared to have been halted by the use of sirolimus, but the assessment of disease in other vessels (particularly the RCA) was of particular importance in deciding whether or not to relist this patient for transplantation. Due to the known limitations of coronary angiography, we used OCT to assess for angiographically silent CAV. The normal intravascular appearance of the RCA by OCT was reassuring, and the child was not relisted for transplantation. OCT offers multiple advantages for the assessment of CAV in children.
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Affiliation(s)
- Steven C Greenway
- Section of Cardiology and Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada
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