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The Annals of Thoracic Surgery, Vol 46, 611-614, Copyright © 1988 by The Society of Thoracic Surgeons

ARTICLES

Heart transplantation in repaired transposition of the great arteries

AL Harjula, LJ Heikkila, MS Nieminen, M Kupari, P Keto and SP Mattila
Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland.

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.

This article has been cited by other articles:

				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]