ST Elevation Myocardial Infarction Early After Heart Transplantation

Intractable coronary fibromuscular dysplasia leading to end‐stage heart failure and fatal heart transplantation

“…The patient underwent HTX, which was complicated by intraoperative acute akinesia of the new heart due to thrombotic occlusion of the graft LAD. Early coronary complications of HTX are very rare and mainly associated with procedural manipulation or directly related to donor heart, especially with CAD, as transmitted atherosclerosis results in a two‐fold to three‐fold increased risk for early graft failure . Most eurotransplat regions recommend to screen every donor over 40 years old by angiography or when it is requested by surgeon (also in our case), when some risk factors are suspected.…”

“…In vivo thrombus extraction during angiography before patient death revealed a white artery thrombus of the LAD, indicating a recent coronary thrombotic event ( Figure B ). Peri‐procedural related inflammation and thrombogenicity increase a risk of myocardial ischaemia . Although painful attention was paid to avoid mechanical damage during the transplantation procedures, the probable cause of the unexpected fatal finding could be related to inadvertent embolism due to manipulation during the complex HTX procedure or, less probably, secondary to hyperacute vascular rejection (although preoperatively direct lymphocyte crossmatch test was negative), or to a putative presence of systemic vascular disease …”