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The Annals of Thoracic Surgery, Vol 46, 611-614, Copyright © 1988 by The Society of Thoracic Surgeons
AL Harjula, LJ Heikkila, MS Nieminen, M Kupari, P Keto and SP Mattila
Cardiac transplantation was carried out in a 40-year-old man with the
diagnosis of repaired transposition of the great arteries and right- sided
aortic arch who had end-stage cardiac failure due to myopathy of the
ventricles. Because of several previous surgical repairs and the
orientation of the great vessels, the operation presented some technical
problems. Therefore, modifications of operative procedures were used,
including recipient hypothermia, circulatory arrest, and changes in the
donor heart implantation. The removal of the donor heart was modified in
such a way that the graft included the aortic arch and both pulmonary
arteries. With the extra length of ascending aorta and transverse arch, the
innominate, left carotid, and left subclavian vessels were excised as a
button, thereby leaving the distal orifice of the aorta in the superior
portion of the transverse arch. For the recipient, the operation was
performed using hypothermic total circulatory arrest to dissect free the
huge pulmonary artery and the short right-sided aortic arch to place the
clamp. Implantation of the donor heart was modified accordingly. The
technical results were confirmed one and a half months later on a control
digital angiogram. Thirty-five days postoperatively the patient was
discharged. Six months after operation, the patient is doing better than
ever before in his life. Our findings suggest that a complicated
conotruncal development does not preclude cardiac transplantation.
ARTICLES
Heart transplantation in repaired transposition of the great arteries
Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland.
This article has been cited by other articles:
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C. Munoz-Guijosa, A. Ginel, J. Montiel, and J. M. Padro Orthotopic heart transplantation in a patient with situs invs, transposition of the great arteries and Mustard operation. Eur. J. Cardiothorac. Surg., July 1, 2008; 34(1): 219 - 221. [Abstract] [Full Text] [PDF] |
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