Orthotopic Heart Transplantation for Congenital Heart Disease with Dextrocardia: A Single-Center Clinic Experience

Figure 1

Outline of operative procedures of patients with cardiac dextroversion. (a) After the recipient cardiectomy, a standard left atrial cuff and a long cuff of systemic atrial tissue in continuity with the inferior vena cava was left. The atrial-atrial anastomosis was performed first between the left superior pulmonary vein (LSPV) orifice on the donor side and the left inferior pulmonary vein (LIPV) orifice on the recipient side. The heart was rotated rightward approximately 90° along its long axis and approximately 30° in the frontal plane. (b) The end-to-end anastomosis between the donor and recipient aorta was next. The recipient’s IVC with an atrial cuff was used to create a large end-to-end anastomosis at the donor’s IVC after enlarging the donor’s IVC orifice. Patient #2 and #4’s left-sided superior vena cava (LSVC) were connected with the donor’s right atrial appendage by vascular prosthesis. Then, a large patch of the donor pulmonary artery was used to create a long anastomosis at the main pulmonary artery. Due to the rotation of the heart, the pulmonary artery was transposed to the right side of the aorta.

(a)

(b)