Cardiac Transplantation Complicated by Acute Thrombotic Occlusion of the Right Coronary Artery


  • Juliane Kilo
  • Daniel Hoefer
  • Ludwig C. Mueller
  • Gerhard Poelzl
  • Guy Friedrich
  • Christoph Hoermann
  • Guenther Laufer
  • Herwig Antretter



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.


Antretter H, Laufer G. 2001. Surgical techniques for cardiac transplantation. Eur Surg ACA 33:17-24.nBlanche C, Freimark D, Valenza M, Czer LS, Trento A. 1994. Heart >transplantation for Q fever endocarditis. Ann Thorac Surg 58(6):1768-9.nBata IR, MacDonald RG, O'Neill BJ. 1993. Coronary artery fistula as a complication of percutaneous transluminal coronary angioplasty. Can J Cardiol 9(4):331-5.nDrobinski G, Dorent R, Ghossoub JJ, et al. 2002. Myocardial infarction after endomyocardial biopsy in a heart transplant patient. J Interv Cardiol 15(5):403-5.nChohan AJ, Kugelmass AD, Kida M, Pennington LR, Sivaram CA. 1998. Coronary artery fistula after cardiac transplantation. Can J Cardiol 14(3):463-5.nDiSesa VJ, Sloss LJ, Cohn LH. 1990. Heart transplantation for intractable prosthetic valve endocarditis. J Heart Transplant 9(2):142-3.nFriesen CH, Howlett JG, Ross DB. 2000. Traumatic coronary artery fistula management. Ann Thorac Surg 69(6):1973-82.nGillebert C, Van Hoof R, Van de Werf F, Piessens J, De Geest H. 1986. Coronary artery fistulas in an adult population. Eur Heart J 7(5):437-43.nShumway NE, Lower RR, Stofer RC. 1966. Transplantation of the heart. Adv Surg 2:265-84.nSteinman TI, Becker BN, Frost AE, et al. 2001. Guidelines for the referral and management of patients eligible for solid organ transplantation. Transplantation 71:1189.nChantranuwat C, Blakey JD, Kobashigawa JA, et al. 1999. Sudden, unexpected death in cardiac transplant recipients: an autopsy study. J Heart Lung Transplant 23(6):683-9.nEccleshall SC, Pitt M, Townend JN. 1997. Transcatheter embolisation of an enlarging acquired coronary arteriovenous fistula in a heart transplant recipient. Heart 78(2):203-5.nBalanescu S, Sangiorgi G, Castelvecchio S, Medda M, Inglese L. 2001. Coronary artery fistulas: clinical consequences and methods of closure. A literature review. Ital Heart J 2(9):669-76.nMiralles A, Serrano T, Calbet JM, Castells E. 1996. Early graft failure after heart transplantation due to coronary artery embolization with myocardial tissue. Eur J Cardiothorac Surg 10(10):916-8.nNawa S, Miyachi Y, Shiba T, et al. 1996. Clinical and angiographic analysis of congenital coronary artery fistulae in adulthood. Is there any new trend? Jpn Heart J 37(1):95-104.nPark SJ, Sullivan HJ, Lonchyna V, Hinkamp TJ, Pifarre R. 1993. Heart transplantation for complicated and recurrent early prosthetic valve endocarditis. J Heart Lung Transplant 12(5):802-3.nPittaluga J, de Marchena E, Posada JD, Romanelli R, Morales A. 1997. Left anterior descending coronary artery bridge. A cause of early death after cardiac transplantation. Chest 111(2):511-3.nVavuranakis M, Bush CA, Boudoulas H. 1995. Coronary artery fistulas in adults: incidence, angiographic characteristics, natural history. Cathet Cardiovasc Diagn 35(2):116-20.nGalbraith AJ, McCarthy J, Tesar PJ, McGiffin DC. 1999. Cardiac transplantation for prosthetic valve endocarditis in a previously transplanted heart. J Heart Lung Transplant 18(8):805-6.nGasser R, Koppel H, Luha O, et al. 2000. Segmental degradation of left ventricular wall motion after persistent coronary fistula in a posttrans-plantation patient: a case report and short review of literature. Transplantation 69(10):2108-11.nHartog JM, van den Brand M, Pieterman H, di Mario C. 1993. Closure of a coronary cameral fistula following endomyocardial biopsies in a cardiac transplant patient with a detachable balloon. Cathet Cardiovasc Diagn 30(2):156-9.nHosenpud JD, Bennett LE, Keck BM, et al for the Society for Heart and Lung Transplantation. 1999. J Heart Lung Transplant 18:611. Lazar JM, Uretsky BF. 1996. Coronary artery fistula after heart transplantation: a disappearing entity? Cathet Cardiovasc Diagn 37(1):10-3.n



How to Cite

Kilo, J., Hoefer, D., Mueller, L. C., Poelzl, G., Friedrich, G., Hoermann, C., Laufer, G., & Antretter, H. (2005). Cardiac Transplantation Complicated by Acute Thrombotic Occlusion of the Right Coronary Artery. The Heart Surgery Forum, 8(5), E311-E313.