TN 8 (11-12)

DI 23022.987 Transplant Coronary Artery Vasculopathy

COMPASSIONATE ALLOWANCE INFORMATION

TRANSPLANT CORONARY ARTERY VASCULOPATHY

ALTERNATE NAMES

Transplant Cardiac Allograft Vasculopathy; Cardiac Transplant Vasculopathy

DESCRIPTION

Cardiac transplantation is a type of therapy used in the treatment of end-stage heart failure. Transplant Coronary Artery Vasculopathy (CAV) is the second most common cause of death after malignancy for individuals receiving a cardiac transplant. Transplant CAV may contribute to heart failure, dangerous changes in heart rhythm (arrhythmias) and sudden cardiac arrest. Immunosuppressive medications such as cyclosporine and corticosteroids that are used to treat transplant CAV, may contribute to endothelial cell injury and intimal hyperplasia (thickening of inner lining of coronary artery walls).

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING

Diagnostic testing: Intravascular ultrasonography (IVUS) is used to detect early coronary artery vasculopathy; Coronary angiogram; dobutamine stress echocardiography; single proton emission CT (SPECT); and multidetector CT.

Physical findings: In addition to the acute cardiac disorders cited above, characteristic features of this disease are non-specific graft failure, multi-organ failure, acute rejection, and infection. Generalized swelling (edema), general discomfort or ill feeling, pain or swelling in the chest close to the heart.

ICD-9: 414.06; 414.07

ONSET AND PROGRESSION

The onset and progression of transplant CAV are variable.

TREATMENT

The disease process of transplant coronary artery vasculopathy is progressive and generally unresponsive to treatment. Revascularization is effective palliative therapy; retransplantation offers a more definitive solution but is limited by organ shortages.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for evaluation:

  • Clinical history and examination that describes the diagnostic features of the impairment.

  • Cardiology consultation reports.

  • Imaging studies of the heart and blood laboratory testing.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets Listing

4.02

4.04

4.05

Listing level severity must be documented.

Medical Equals

  

* Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423022987
DI 23022.987 - Transplant Coronary Artery Vasculopathy - 11/30/2012
Batch run: 11/30/2012
Rev:11/30/2012