A perilous course following myocardial infarction: ischaemic ventricular septal defect in a transplanted heart.

Coronary artery disease in the donor heart is an established cause of early graft failure. However, identification of this before implantation is difficult. Cardiogenic shock associated with significant myocardial infarction during the early postoperative period is rare. Here, we report a case of a 42-year-old man who presented acutely with cardiogenic shock; he was supported by short-term extracorporeal support as a bridge to transplantation. Following successful orthotopic heart transplantation, he sustained coronary artery atheromatous plaque rupture, resulting in acute coronary artery occlusion, and subsequently developed an ischaemic ventricular septal defect on the third postoperative day.