Albanian Journal of Trauma and Emergency Surgery (2020) 4/2: 732 - 737 DOI: 10.32391/ajtes.v4i2.111 CASE REPORTS Anaesthesia for Vaginal Prolapse Surgery in the Heart Transplant Recipient. A Case Report Saimir KUCI 1* , Adriana MISJA 1 , Alfred IBRAHIMI 1 , Ermal LIKAJ 2 , Petrit REXHEPI 3 , Orion GLIOZHENI 3 , Ilir OHRI 1 Received: 10 November 2019 / Accepted: 25 November 2019 / Published online: 20 July 2020 © The Author(s) 2020. This article is published with open access at https://journal.astes.org.al Abstract Introduction: Nowadays, we need to deal with heart transplanted patients for other medical concerns. So, it is important to see in detail different aspects and modalities of their care during other types of surgery. A transplant team will carefully monitor each heart trans-plant recipient and should be possible to seek information on the patient’s overall status. They will be able to inform on the most recent investigations (ECG to assess graft function, recent biopsy for rejection, angiography for coronaries, etc.). Case report: Our patient, a 65-year-old lady underwent heart transplantation 5 years before. The cardiac situation was stable and she was doing fne. She was recovered in the gynaecological clinic with a diagnosis of vaginal prolapse with surgical indication General anaesthesia was done with fentanyl 7 ml, pavulon 4 mg, propofol 200 mg and sevofurane 1.5-2.2%. The patient was monitored during surgery with SpO2, ECG, IBP, CVP. The operation technique was open of vaginal plastic repair. Discussion: By 3 months, most recipients of heart transplant came under New York Heart Association (NYHA) I class. The last UK national survey about health-related quality of life after cardiac transplantation indicates that, 1 year after surgery, there is an improvement in quality of life (60% are much better; 28% somewhat better) and there is no deterioration in general health at 3–5 years, except that many of them have symptoms compatible with depression. Conclusion: Perioperative care of heart transplant recipients will entail a greater attention to maintaining an adequate preload and vascular tone, to avoiding infections and to being aware of the multiple side effects of immunosuppressive therapy. References and recommended reading Papers of particular interest, published within the annual period of review, have been highlighted as: of special interest of outstanding interest Additional references related to this topic can also be found in the Current World Literature section in this issue Keywords: Heart trasplant, denervated organ, immunosuppressants These patients often require the expertise of nontransplant specialists when they present with new health problems, sometimes many years after their transplant. Anaesthetists need to remain abreast of new developments in the feld of cardiac transplantation. Discussing the patient with the transplant team in advance of potential surgery will help minimize problems in the perioperative period. Physiology of the transplanted heart The transplanted heart is a denervated organ, but intrinsic cardiac mechanisms are preserved and the heart will be exquisitely sensitive to changes in flling conditions, and the Starling volume–pressure relationship becomes paramount in adjusting contractility. The resting heart rate is high (90 – 100 bpm) as vagal tone is lost. Tachycardia in response to physiological stress (such as hypovolaemia) is blunted as it depends on Introduction The patient with heart transplant can be managed as any other patient, and a careless anaesthetist could cause great harm by doing so; however, the days when these patients were handled exclusively by specialized teams are long gone. Original article, no submission or publication in advance or in parallel * Corresponding author: Saimir KUÇI MD, PhD * saimirkuci@gmail.com 1 Department of Anaesthesiology University Hospital Centre “Mother Teresa” Tirana, ALBANIA 2 Department of Cardiac Surgery, University Hospital Centre “Mother Teresa” Tirana, ALBANIA 3 Department of Obstetrics and Gynecology “Koco Gliozheni” Hospital, Tirana, ALBANIA