Optical coherence tomography for the evaluation of asymmetric cardiac allograft vasculopathy in a child.

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.