Coronary allograft vasculopathy (CAV) is a major cause of long-term graft loss following pediatric heart transplantation.1 Invasive coronary angiography (ICA) remains the golden standard for diagnosis and surveillance but carries procedural risks and challenges, especially in younger patients requiring repeated studies. Coronary computed tomography angiography (CCT) offers a non-invasive alternative with high spatial resolution. The addition of CT-derived fractional flow reserve (FFRct) may prov…