Diagnosis and management of coronary allograft vasculopathy in children and adolescents

Table 1 ISHLT consensus grading for coronary allograft vasculopathy (Mehra et al[13] 2010)

Grade
0 (Not significant)	No detectable angiographic lesion
I (Mild)	Angiographic LM < 50% stenosis, or primary vessel with maximal lesion of < 70%, or any branch stenosis of < 70% ( including diffuse narrowing)
II (Moderate)	Angiographic LM 50%-69% stenosis, a single primary vessel ≥ 70% stenosis, or isolated branch stenosis of ≥ 70%in branches of 2 systems
III (Severe)	Angiographic LM ≥ 70%, or 2 or more primary vessels ≥ 70% stenosis, or isolated branch stenosis of ≥ 70% in all 3 systems, or mild/moderate angiographic disease with LVEF < 45% or evidence of significant restrictive physiology (i.e., symptomatic heart failure with echocardiographic E to A velocity ratio > 2 (> 1.5 in children), shortened isovolumetric relaxation time (< 60 ms), shortened deceleration time (< 150 ms), or restrictive hemodynamic values (Right Atrial Pressure > 12 mmHg, Pulmonary Capillary Wedge Pressure > 25 mmHg, Cardiac Index < 2l min/m2)

LM: Left main.

Table 2 Stanford score (severity based on the localization of the most severe disease

Grade	Severity	Intimal thickness
I	Minimal	< 0.3 mm and < 180 degrees
II	Mild	< 0.3 mm and > 180 degrees
II	Moderate	0.3-0.5 mm
		OR
		0.5-1 mm and < 180 degrees
IV	Severe	> 1 mm
		OR
		0.5-1 mm and > 180 degrees