Orthotopic Cardiac Transplantation for Left Ventricular Hypoplasia Syndrome

Abstract

The hearts of patients with hyperplastic left heart syndrome are almost normal in size and smaller than the hearts of patients with dilated cardiomyopathy, so the heart of a brain-dead neonate with comparable size could be selected as a donor heart. A double atrium cardiac transplantation is the earliest classic technique. The operation method is relatively simple. However, there are four atria in total, two from the donor and the two of the recipient, in one patient after heart transplantation, so the postoperative atrium is accordingly enlarged. Because action between the inherent and the donor’s sinoatrial nodes cannot maintain coordination, there is a possibility of electrophysiologic disturbances in the natural atrium. Arrhythmia is another potential complication because the right atrial anastomosis is much closer to the sinoatrial node, and because the donor’s right atrium can be distorted due to a mismatch between the donor and recipient hearts. The bicaval heart transplantation, as its name suggests, is a technique to fashion a superior/inferior vena caval end-to-end anastomosis between the donor and recipient hearts during heart transplantation. In recent years, the bicaval technique has been widely adopted.