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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.

Aim. Evaluation of prognostic significance of the parameters of cardiopulmonary exercise test in life quality improvement for the post-cardiac transplantation patients.Material and methods. Into the study, 40 patients included, with severe chronic heart failure (CHF), included in the waiting list for cardiac transplantation. Before and after orthotopic heart transplantation (OHT), clinical status was evaluated, cardiopulmonary exercise testing parameters (CET) and life quality by SF-36.Results. After OHT the significant life quality improvement noted, by the scale “Physical health” from 36 (32-45) points before surgery to 52 (49-55) points (p

Aim. Donor organ injury during cold preservation before transplantation negatively impacts graft survival. The current study was to examine available evidences for the efficacy of different cold storage solutions that are used to preserve donor hearts in vitro prior to orthotopic transplantation.Material and methods. A systematic search of full-length articles published from 1980 to August 2012 was performed in PubMed and Google Scholar. Detailed searches were also made for availability of any sourceware for histopathology images of endomyocardial biopsies of stored hearts.Results. Not even a single controlled trial has been published relating to this topic. However, we assessed all available literature pertaining to this topic, and performed original, simple yet innovative analyses using ImageJ, a Java based image analyses program, to show the tremendous power to objectively examine the efficacy of the storage solution. Our analysis suggest that ImageJ may be conveniently used to obtain evidences (or lack of it) of ischemic injury of donor hearts during cold storage.Conclusions. Even the UNOS database does not provide histopathological evidences of cardiac biopsies of orthotopically transplanted hearts. We, however, make the case of the need for image analyses and making availability of images to allow establishing evidence of the usefulness of these storage solutions. We recommend obtaining endomyocardial biopsy prior to orthotopic transplantation and create a registry of H&E stained slides. This is the only step that will direct us towards evidence based care of such highly critical patients who need the equally challenging surgical intervention of cardiac transplantation.