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A perilous course following myocardial infarction: ischaemic ventricular septal defect in a transplanted heart

Eshan L Senanayake1, Harjot Singh2, Aaron M Ranasinghe1

  • 1Department of Cardiac Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.

Interactive Cardiovascular and Thoracic Surgery
|May 31, 2014
PubMed

Insights

Donor heart coronary artery disease can cause early graft failure, but is hard to detect pre-transplant. This case shows acute coronary plaque rupture post-transplant leading to graft dysfunction.

Area of Science:

  • Cardiology
  • Transplant Surgery
  • Cardiovascular Research

Background:

  • Coronary artery disease (CAD) in donor hearts is a known risk factor for early graft failure.
  • Pre-implantation identification of donor heart CAD remains a significant clinical challenge.
  • Early postoperative cardiogenic shock from myocardial infarction is a rare but serious complication.

Observation:

  • A 42-year-old male presented with acute cardiogenic shock.
  • The patient received short-term extracorporeal support as a bridge to orthotopic heart transplantation.
  • Following successful transplantation, the patient experienced coronary artery atheromatous plaque rupture.

Findings:

  • The plaque rupture led to acute coronary artery occlusion.
  • This resulted in an ischemic ventricular septal defect (VSD) on postoperative day three.
  • The case highlights a rare post-transplant cardiac event.

Implications:

  • This case underscores the potential for severe complications even after successful heart transplantation.
  • It emphasizes the need for vigilance regarding coronary events in the early post-transplant period.
  • Further research may be needed to improve detection and management of donor heart atherosclerosis and its complications.

Keywords:
Atheromatous plaqueHeart transplantMyocardial infarctionVentricular septal defect

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