Cardiac transplantation complicated by acute thrombotic occlusion of the right coronary artery.
We report the case of a 63-year-old male patient undergoing cardiac transplantation due to fourth time aortic valve endocarditis. The postoperative course was complicated by thrombotic occlusion of the right coronary artery (RCA) causing acute right ventricular myocardial infarction, which required extracorporeal membrane oxygenation. The RCA could be reopened by catheter-based intervention and the patient stabilized. In order to avoid further immobilization, a right ventricular assist device was implanted and an aortocoronary bypass to the RCA was performed. After that, the patient stabilized progressively, could be weaned from the assist device, and was discharged home 6 weeks after transplantation. On coronary angiography, which is routinely performed 4 to 6 weeks after transplantation, a fistula from the RCA to the right ventricle was detected which was treated conservatively. Five months after transplantation, the patient is in good clinical condition without signs of recurrent endocarditis. This case shows that intense interdisciplinary cooperation of cardiac specialists allows the successful management of very complex patients in serious clinical conditions.
Kilo
Juliane
J
Department for Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria. juliane.kilo@uklibk.ac.at
Hoefer
Daniel
D
Mueller
Ludwig C
LC
Poelzl
Gerhard
G
Friedrich
Guy
G
Hoermann
Christoph
C
Laufer
Guenther
G
Antretter
Herwig
H
D001021:Aortic Valve; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D003328:Coronary Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D004696:Endocarditis / Q000601:surgery; D015199:Extracorporeal Membrane Oxygenation; D016027:Heart Transplantation / Q000009:adverse effects*; D006352:Heart Ventricles; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000628:therapy; D012008:Recurrence; D015607:Stents