Terminal Graft Failure

The objectives are to describe the pathology findings from the examination of the explanted heart and correlate them with clinical variables such as catheterization data. Children's Healthcare of Atlanta performs approximately 12-15 heart transplants a year. To date, there have been 19 re-transplantations for late graft failure at Children's. The pathologic and clinical records of these 19 patients will be studied. All data collected will be entered into a database for future analysis. Data Collection A retrospective review of standard pathology findings from the examination of the explanted hearts will be conducted in order to determine the following: 1. Evidence of CAV (coronary allograft vasculopathy) 2. Evidence of Endocardial fibroelastosis 3. Evidence of Rejection (acute and chronic) 4. Evidence of Myocardial infarction 5. Evidence of Fibrosis 6. Evidence of Fatty infiltration A retrospective review of patient charts will also be utilized to compare the pathologic findings to clinical data obtained prior to re-transplantation. The following information will be collected: 1. Type of transplant method 2. Patient age at time of transplant 3. Echocardiographic Data including Tissue Doppler Imaging (if available) 4. Catheterization data 1. CAV as identified by coronary angiography 2. Ventricular end-diastolic pressure 3. Cardiac index 4. Ventricular ejection fraction 5. Clinical rejection history