Coronary artery involvement in chronic graft‐versus‐host disease presenting as sudden cardiac arrest

Abstract

Graft‐versus‐host disease (GVHD) is related to considerable morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Cardiac complications associated with GVHD are uncommon, and coronary artery involvement is even more unusual. We report on a male pediatric patient with chronic GVHD who developed a fatal ventricular arrhythmia caused by coronary artery obstruction after HSCT. At 30 months after HSCT, he suddenly collapsed with ventricular fibrillation. After resuscitation, electrocardiography showed abnormal q‐wave and ST changes in the inferior leads, suggesting a coronary event. Coronary angiography revealed complete obstruction of the proximal left anterior descending artery, subtotal obstruction of the mid left circumflex artery, and mild narrowing at the right coronary artery. This boy had none of the risk factors for coronary artery disease, and the only possible explanation for the cardiac event is GVHD. Coronary artery disease only rarely occurs as a cardiac event in children. However, coronary artery involvement should be recognized as one of the important manifestations of chronic GVHD in children.

A case study of successful percutaneous coronary intervention in a young adult with chronic graft-versus-host disease with acute coronary syndrome

“…Furthermore, our patient was exposed to chronic steroids, a known risk factor for cardiovascular disease [9]. There are other case reports, however, of patients with GVHD and severe coronary artery luminal narrowing, who had no risk factors for CAD [4,5]. On review of our patient's medications, there were no known medications associated with other etiologies of anginal chest pain, such as coronary vasospasm.…”

“…When cardiac complications do occur in these patients, they are typically secondary to chemotherapy toxicity, direct radiation exposure to the chest, immunemediated therapies, or infections. Thus far, only three cases of suspected acute coronary syndrome (ACS) secondary to GVHD have been reported in the literature in pediatric patients [3][4][5]. Only one of these cases resulted in percutaneous coronary intervention (PCI), while the others resulted in mortality.…”