Myocardial infarction in a patient after orthotopic heart transplantation, causes of development and management features
This article describes a clinical case of management of a patient with myocardial infarction (MI) who underwent orthopic heart transplantation. The main cause of myocardial infarction in a transplanted heart is cardiac allograft vasculopathy (ICA), a rapidly progressive form of atherosclerosis. The process involves concentric narrowing of the lumen of the coronary arteries, usually occurring from several months to several years after transplantation. Currently, ICA is the limiting factor in the long-term survival of the allograft. According to the registry of the International Society for Heart and Lung Transplantation (ISHLT), angiographic signs of ICA are found in 8-10 % of patients after 1 year, in 20 % after 3 years, in 30 % after 5 years, in 45 % after 8 years, and more than in 50 % after 10 years. This article presents the latest available pathophysiological data on ICA, methods of diagnosis, prevention, management, treatment and further prognosis of myocardial infarction in patients with heart transplants. In addition, a clinical case of a patient with myocardial infarction without ST-segment elevation after orthotopic heart transplantation is described. The authors participated in the development of the concept and design of the article. The manuscript is grounded and verified for the importance of intellectual content. The manuscript was finally approved by the authors for publication. The authors agree to be responsible for all parts of the work.