|Home | About | Journals | Submit | Contact Us | Français|
A 55-year-old man who received elective orthotopic heart transplantation with a 28-year-old donor heart was found to have ST elevation on the monitor, noticed by nursing staff on telemetry, the morning following surgery. A 12-lead ECG confirmed a current of injury in the anterior, apical, inferior and lateral leads (figure 1). The patient was taken immediately to the cardiac catheterisation laboratory for primary percutaneous coronary intervention (PCI). Coronary angiogram showed total thrombotic occlusion of mid left anterior descending (LAD) artery (video 1). Stenting of the mid LAD artery was necessary after four runs of aspiration thrombectomy and balloon angioplasty (POBA) of a residual moderate stenosis, with complete resolution of the stenosis and re-establishment of TIMI (thrombolysis in myocardial infarction) 3 flow (video 2). The patient subsequently had endomyocardial biopsy weekly as per protocol, which showed ISHLT (International Society for Heart and Lung Transplantation) Grade 0 for cellular rejection and negative antibody-mediated rejection. Echocardiogram showed ejection fraction of 45% with anterior and anteroseptal hypokinesis.
To the best of our knowledge, this is the first case of post-transplantation ST elevation myocardial infarction (STEMI) developing within 24 h of transplant with a young donor heart. The time frame of presentation and negative biopsy status make immune-mediated vasculopathy an unlikely mechanism for acute STEMI in this patient. The stress of the surgery most likely triggered decompensation of the mid-LAD plaque leading to STEMI. This case emphasises the need for screening younger donor hearts for coronary artery disease, especially those from donors with a history of smoking, as was the case here, and possibly the need for change in pretransplant screening guidelines in such high-risk young donors. The case also highlights the importance of keeping a high clinical suspicion for ischaemia in transplant recipients, as the presentation is not similar to that in patients with a normal heart.1
Competing interests: None declared.
Patient consent: Obtained.
Provenance and peer review: Not commissioned; externally peer reviewed.