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Stenting of unprotected left main stem stenosis in cardiogenic shock after orthotopic heart transplantation

^a Department of Cardiology, Marienkrankenhaus Hamburg and Universitätsklinik Freiburg, Hamburg, Germany
^b Department of Cardiac Surgery, Universitätsklinik Freiburg, Hamburg, Germany

*Corresponding author. Department of Cardiology – Zentrum Innere Medizin, Marienkrankenhaus Hamburg and Universitätsklinik Freiburg, Alfredstr. 9, D-22087 Hamburg, Germany. Tel.: +49-40-25462101; fax: +49-40-25462100.

E-mail address: vandeloo.innere{at}marienkrankenhaus.org (A. van de Loo).

We report the spectacular case of a young patient who developed cardiogenic shock caused by significant stenosis of the left main stem 8 years after orthotopic cardiac transplantation. Immediate percutaneous coronary intervention was a life saving procedure. The report illustrates the importance of early coronary angiography for the clinical management of heart transplant patients in cardiogenic shock as a relevant differential diagnosis to acute rejection. Allograft vasculopathy can develop unexpectedly even after years of uncomplicated follow-up.

Key Words: Heart transplantation; Transplant vasculopathy; Cardiogenic shock; Percutaneous intervention