Abstract
This clinical case describes a patientwho was diagnosed with mitral valve prolapse in childhood. Subsequently, the patient was diagnosed with dilated cardiomyopathy with progressive reduction of ejection fraction down to 20%. In 2014, an implantable cardioverter-defibrillator (ICD) was placed.Over time, the patient's condition worsened due to the progression of chronic heart failure symptoms and the lack of significant effect from conservative therapy. Based on the decision of a medical board, in February 2015, a left ventricular assist device (LVAD) —the HeartMate III —was implanted as a bridge to heart transplantation. The early postoperative period was complicated by right ventricular failure.In July 2017, after 2.5 years on mechanical circulatory support, the patient underwent orthotopic bicaval heart transplantation under conditions of cardiopulmonary bypass and hypothermia. The early postoperative period was complicated by acute renal failure, requiring prolonged hemodialysis sessions, as well as an episode of acute humoral (and cellular) transplant rejection.After a course of pulse therapy with methylprednisolone (1 g for 3 days), the patient's condition improved. Lifelong immunosuppressive therapy was initiated, including tacrolimus (Prograf), methylprednisolone, and mycophenolic acid (Myfortic), along with prophylactic therapy with valganciclovir (Valcyte) for six months post-transplant, followed by a switch to acyclovir. In addition, supportive therapy was prescribed, including antiplatelet, lipid-lowering, and gastroprotectiveagents.At present, the patient is on continuous therapy with acetylsalicylic acid (Thrombo ASS), a β-blocker (bisoprolol), and combined lipid-lowering therapy (Rosulip Plus).Keywords: dilated cardiomyopathy, chronic heart failure, heart transplantation, postoperative period, immunosuppressive therapy.