[Orthotopic heart transplantation: a case report]

Area of Science:

• Cardiology
• Transplantation Surgery
• Immunology

Background:

• Orthotopic heart transplantation is a complex procedure for end-stage heart disease.
• Hypertrophic cardiomyopathy presents unique surgical challenges, especially with prior cardiac surgery.
• Effective immunosuppression and rejection monitoring are critical for long-term graft survival.

Observation:

• A patient with hypertrophic cardiomyopathy and prior right ventricular outlet surgery underwent successful orthotopic heart transplantation.
• The donor heart was protected using retrograde perfusion with oxygenated blood and St. Thomas cardioplegia.
• The patient received triple-drug immunosuppression and methylprednisolone for acute rejection.

Findings:

• The patient achieved an excellent postoperative result with good cardiac, hepatic, and renal function.
• Acute rejection was successfully managed with a high dose of methylprednisolone.
• The described donor heart preservation technique ensured graft viability.

Implications:

• This case highlights the feasibility of heart transplantation in complex hypertrophic cardiomyopathy patients.
• Noninvasive monitoring, alongside endomyocardial biopsy, can aid in acute rejection detection.
• Optimized donor heart management and immunosuppressive strategies contribute to favorable long-term outcomes.