Cardiac Transplant Vasculopathy; Transplant Cardiac Allograft Vasculopathy; Transplant Coronary Artery Vasculopathy

Cardiac transplantation is a type of therapy used in the treatment of end-stage heart failure. Cardiac allograft vasculopathy (CAV) may affect an individual who has received a heart transplant and involves thickening in the walls of the coronary arteries that may progress quickly into serious vascular stenosis and heart dysfunction. CAV is the second most common cause of death after malignancy for individuals receiving a cardiac transplant.

Cardiac denervation at the time of heart transplantation usually prevents individuals from experiencing angina which is an important warning sign for heart disease. Because of this lack of early clinical symptoms, individuals with CAV typically present late with silent myocardial infarction, loss of allograft function or sudden death.

Due to diffuse nature of intimal thickening in CAV, coronary angiography is not as sensitive and accurate as it is in native coronary artery disease (CAD).

Diagnostic testing:

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  Intravascular ultrasonography (IVUS) is used to detect early coronary artery vasculopathy;

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  Coronary angiogram;

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  Dobutamine stress echocardiography;

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  Single proton emission computed tomography (SPECT); and

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  Multidetector computed tomography (CT).

Physical findings:

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  Heart failure;

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  Dangerous changes in heart rhythm (arrhythmias);

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  Sudden cardiac arrest;

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  Non-specific graft failure;

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  Multi-organ failure;

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  Acute rejection;

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  Infection;

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  Generalized swelling (edema);

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  General discomfort or ill feeling; and

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  Pain or swelling in the chest close to the heart.

Immunosuppressive medications such as cyclosporine and corticosteroids that are used to treat CAV, may contribute to endothelial cell injury and intimal hyperplasia (thickening of inner lining of coronary artery walls).

ICD-9: 414.06; 414.07

ICD-10: T86.290

Although the progression of CAV is variable, generally the course is progressive with limited therapeutic options.

The disease process of CAV 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 MER for Evaluation:

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  Clinical history and examination that describes the diagnostic features of the impairment;

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  Cardiology consultation reports; and

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  Imaging studies of the heart and blood laboratory testing.

Suggested Listings for Evaluation:

4.16

Listing-level severity must be documented.

104.16

Listing-level severity must be documented.