Thromboaspiration during acute myocardial infarction in a heart transplant patient

Each year, an estimated 10% of heart transplant recipients develop coronary allograft vasculopathy, an aggressive form of coronary artery disease that limits survival after transplantation. The pathologic characteristics of coronary allograft vasculopathy are not uniform and both the clinical importance and pathophysiological significance of thrombosis and vasospasm in this setting are not completely understood. Mechanical reperfusion is a better alternative to systemic thrombolysis in patients with acute myocardial infarction and thrombus removal before standard percutaneous coronary intervention improves coronary epicardial flow. We report the case of a 38-year-old male admitted to the emergency room of our hospital with acute inferior myocardial infarction complicated by cardiogenic shock. He underwent heart transplant because of ischemic cardiomyopathy. Coronary angiography showed acute coronary thrombosis of the circumflex coronary artery. Percutaneous coronary intervention with thrombus extraction was successfully attempted. This case represents an unusual clinical presentation and treatment of cardiac allograft vasculopathy.