Early graft failure after heart transplantation due to coronary artery embolization with myocardial tissue

Myocardial infarction due to myocardial tissue embolism of the right coronary is a rare cause of early graft failure. We report one case with such a complication, in a 44-year-old man who was transplanted with a graft from a 32-year-old male donor. Prolonged refractory cardiogenic shock developed after orthotopic heart transplantation. A right coronary artery bypass graft was performed and the patient was supported with a biventricular assist device for 69 h. Despite that, no improvement of the graft contractility was observed and the patient could not recover from shock. Pathologic examination showed inferior and septal acute infarction. An embolus of myocardial tissue was completely occluding the first portion of the right coronary artery. The tissue probably came from suture lines of the left atrium.