A Rare Cause of Shock After Orthotopic Heart Transplant

A 58-year-old woman with non-ischemic cardiomyopathy, hypertrophic cardiomyopathy, and a previous orthotopic heart transplant presented to the authors’ institution with cardiogenic shock. Cardiac output was reduced but no coronary stenoses were present during cardiac catheterization. Transesophageal echocardiography (TEE) showed P3 flail segment of the mitral valve and severe mitral regurgitation. An intra-aortic balloon pump was placed, but this device was subsequently removed because of the presence of thrombus and concerns for infection.