Heart transplantation after emergency coronary artery bypass for failed angioplasty.

We describe the case of a 48-year-old woman who required emergency coronary artery bypass grafting because of extensive dissection, cardiogenic shock, and ventricular fibrillation after failed percutaneous transluminal coronary angioplasty for stenosis of a proximal left anterior descending coronary artery. Despite maximal inotropic support and intra-aortic balloon pumping, the patient could not be weaned from cardiopulmonary bypass, and a left ventricular assist device was placed. After 2 days of postoperative circulatory support, during which her respiratory and renal functions declined and cardiac output remained negligible due to a massive myocardial infarction, she underwent successful orthotopic heart transplantation.