Cardiac allograft vasculopathy (CAV) is a complication that can occur after a heart transplant and which can ultimately cause graft failure. Its pathogenesis is not fully understood but may be related to loss of tissue plasminogen activator and impaired fibrinolysis.
Features of CAV:
(1) It is a rapidly progressive form of atherosclerosis.
(2) It involves a fibroproliferative process that causes concentric narrowing of all or most cardiac arteries. This can be observed by coronary angiography.
(3) It may present as a silent myocardial infarction, serious cardiac arrhythmia or cardiac arrest.
(4) Advanced CAV is treated by retransplantation.
Criteria for severe CAV - one or more of the following:
(1) stenosis of the left main coronary artery > 70%
(2) stenosis in 2 or more primary coronary arteries > 70%
(3) branch stenosis in all 3 systems > 70%
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