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Right ventricular (RV) remodeling and impaired function is a recognized phenomenon in patients with advanced pulmonary hypertension (PH). Coronary microvascular dysfunction (CMD) may be involved in RV remodeling and no study to date has investigated this. CMD is defined by structural and functional abnormalities of coronary microvasculature that impairs coronary blood flow and oxygen delivery to the myocytes. Heart transplant recipients offer a unique opportunity to review explanted hearts for evidence of CMD. Due to the nature of their underlying cardiac disease, these patients are categorized as Group 2 PH. Group 2 PH is categorized as either isolated post-capillary PH or combined post-and pre-capillary PH. We performed histopathologic review on explanted hearts from heart transplant recipients to assess the presence of CMD in Group 2 PH. We studied the hearts of 3 patients …