ABSTRACT
The techniques and outcomes of heart transplantation in the pediatric population continue to improve over the years, although the supply of organs remains limited. Donor-to-recipient size matching is critical, especially in neonates and small infants. We present a novel strategy for heart transplantation that includes the Lecompte maneuver because of the features of the donor allograft available in a 8-month-old patient with a cardiac fibroma. We discuss the basis principles for extending the indication of this procedure to exceptional transplantation scenarios and describe the results at long-term follow-up.
Subject(s)
Fibroma/surgery , Heart Neoplasms/surgery , Heart Transplantation/methods , Heart/anatomy & histology , Female , Humans , Infant , Organ SizeABSTRACT
Modified techniques for orthotopic heart transplantation are mandatory when complex congenital anomalies are associated in adult patients. An unusual case of a heterotaxy syndrome and dilated cardiomyopathy following mitral ring annuloplasty is presented in a 62-year-old male. Orthotopic cardiac transplantation was performed by using a modified operative strategy: selective peripheral and central venous cannulation according to the thoraco-abdominal venous challenges, biatrial technique, and preservation of venous drainage via the native coronary sinus. We discuss the anatomical features of heterotaxy in adult patients and surgical approaches when heart transplantation is needed.
Subject(s)
Heart Transplantation/methods , Heterotaxy Syndrome/surgery , Cardiomyopathy, Dilated/complications , Catheterization, Central Venous/methods , Catheterization, Peripheral/methods , Coronary Sinus , Drainage , Heterotaxy Syndrome/etiology , Heterotaxy Syndrome/pathology , Humans , Male , Middle Aged , Mitral Valve AnnuloplastyABSTRACT
A need persists for Fontan conversion that provides alternative approaches for the individual anatomical challenges occurring in these unusual and complex adult patients. The pulmonary arteries present unique variations and the surgical technique needs to be intraoperatively addressed. We describe a technique for Fontan conversion for performing the distal anastomosis of the extracardiac conduit, allowing adequate matching to the pulmonary arteries and preserving an optimal flow into the Fontan circuit.
