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We present a clinical case of an ischemic stroke in a young man, 37 years in the setting of severe cardiac pathology (coronary heart disease, repeated myocardial infarctions with a cardiomyopathy and progressing chronic heart failure). This patient had an orthotopic heart transplantation. In a month we observed an intense violation of cerebral blood circulation, the diagnosis was established: an ischemic stroke in the right carotid pool with formation of the advanced area of ischemia in the right frontotemporal and subcortical area. Total condition was complicated with cerebral edema and dislocation syndrome.In the course of diagnostic search this patient demonstrated genetically caused thrombophilic predisposition in the form of gene-mutation of the blood coagulating factor – plasminogen activator inhibitor (PAI - heterozygote), a glycoprotein Ia (ITAG 2 heterozygote), F7 heterozygote; the genetic polymorphism associated with violation of a folate cycle - MTHFR 1298 heterozygote, MTR heterozygote. The revealed mutations in heterozygous state genes with predisposition to thrombophilic complications can serve as a background for disorders in anti-coagulation and coagulation system which can appear at identification the factors starting the mechanism of its development. In a case with this patient, we speak about a secondary thrombophilia as a reason of an ischemic stroke in the setting of cardiac pathology, repeated myocardial infarctions, orthotopic heart transplantation, obesity. All above-mentioned factors allowed to administer reasonable pathogenetically justified antiagregant and anticoagulant therapy, folic acid drugs, group B vitamins for a purpose of secondary prevention of thrombotic complications.

The mortality rate reaches 50% in the patients with a terminal cardiac failure within one year after it is diagnosed. Orthotopic cardiac transplantation is a radical method to solve this problem and enhance life quality of such patients. Even 10 years ago this surgery and the most important post-transplantation management could be performed only by leading research centers. Currently, given the improvement and accessibility of cardiac surgery, anesthesiology, intensive care, cardiology, and immunology, this type of surgery and post-transplantation management have been mastered by multi-specialty regional centers. The latter improves the accessibility of high tech care for people residing in the periphery.