Left anterior descending coronary artery bridge: contraindication to cardiac transplantation?

Area of Science:

• Cardiology
• Transplantation immunology

Background:

• Myocardial bridging (MB) is an anatomical variation where a segment of a coronary artery travels within the heart muscle. Its impact on cardiac allograft outcomes is not well-established.
• The increasing demand for donor hearts necessitates evaluating all potential donor organs, including those with anatomical variants like MB.

Observation:

• Two cases of cardiac transplantation involving donor hearts with left anterior descending (LAD) myocardial bridging are presented.
• In one case, LAD MB was diagnosed post-transplant; in the other, it was identified pre-operatively, and the organ was accepted for a marginal recipient.
• Both recipients experienced excellent peri-operative outcomes without cardiac complications.

Findings:

• The presence of LAD myocardial bridging in donor hearts did not lead to peri-operative complications in these two cases.
• The study suggests that MB is not an absolute contraindication for cardiac transplantation.
• The relationship between MB and donor heart rejection requires further investigation.

Implications:

• A more liberalized acceptance criteria for donor hearts with MB could expand the donor pool.
• This approach may improve access to life-saving cardiac transplantation for a greater number of patients.
• Further research is warranted to fully understand the long-term implications of MB in transplanted hearts.