Cardiac transplantation for spontaneous coronary artery dissection

We report a 49-year old female who presented with ST elevation myocardial infarction, in whom thrombolysis and coronary angioplasty failed to perfuse the myocardium. She was unsuitable for emergency coronary artery bypass grafting surgery due to the interval elapsed between the myocardial infarction, thrombolysis and large infracted myocardium. Ventricular-assisted device support for a bridge to recovery or transplantation is a widely accepted treatment modality; however, in this case, it was unadvisable due to the extent of the infarcted myocardium and the risk of suturing outflow ports into the infracted myocardium. The patient's condition was stabilized with cardiac inotropic support, intra-aortic balloon counter pulsation and extracorporeal membrane oxygenation as a last resort until a heart became available for transplantation. The patient received successful orthotopic heart transplantation 4 days after her initial presentation and her postoperative recovery was uneventful.