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HEART
Cardiac Transplantation for Congenitally Corrected Transposition of
the Great Arteries: A Case Report
S.-H. Sue, J. Wei, Y.-C. Chuang, C.-Y. Chang, W.-C. Lee, and S.-L. Lee
ABSTRACT
Orthotopic heart transplantation (HTx) was successfully performed in a 46-year-old man
with congenitally corrected transposition of the great arteries. Because of the need for an
extraordinary length of aorta, we preserved the aortic arch during harvesting of the donor
organ. The allograft was implanted using a biatrial technique, but the heart might have to
be rotated clockwise due to the posteriorlyy located pulmonary artery. The patient was well
at 4 years after HTx. HTx in corrected transposition of the great arteries is technically
feasible. Preservation of the aortic arch of the donor’s heart may be necessary to achieve
a good anatomic correction. The long-term results of such an operation are as good as
other HTx procedures.
M
ANY PATIENTS WITH congenitally corrected
transposition of the great arteries (L-TGA) develop
heart failure, but only few cases undergo heart transplantation (HTx).1–3 According to the Registry of the International Society for Heart and Lung Transplantation in 2007,
only 3.2% HTx were performed for congenital heart disease
in the adult population.4
CASE REPORT
The 46-year-old men began to have heart palpitations in 1992.
At a local hospital, he was diagnosed to have congenitally
corrected transposition of the great arteries (L-type) with mild
regurgitation of the systemic atrioventricular (A-V) valve. Over
the following years, symptoms of exertional dyspnea became
exaggerated, and echocardiogram showed severe A-V valve
regurgitation. In 2000, he received a prosthetic valve replacement, which functioned well although the signs of congestive
heart failure persisted. Despite maximal medical therapy, his
condition deteriorated. The cardiac index was 1.9 L/min/m2 and
the pulmonary artery (PA) pressure, 63/45 mm Hg. Finally, he
received an HTx in August 2003.
Operative Technique
During the harvest of the donor heart, we preserved the aortic
arch. The PA was cut at the bifurcation. The recipient left
femoral artery and both vena cavae were cannulated for cardiopulmonary bypass. The recipient heart was excised as usual. A
biatrial technique was used for the atrial anastomosis. After
finishing the anastomosis of the left and right atria, we brought
the heart in a clockwise rotation for the PA anastomosis. The
aortic anastomosis was the last performed. The three branches
From the Heart Center, Cheng-Hsin General Hospital, ChengHsin Rehabilitation Medical Center, Taipei, Taiwan, Republic of
China.
Address reprint requests to Jeng Wei, MD, MSD, Cheng-Hsin
General Hospital, 45 Cheng-Hsin Street, Pei-Tou, 112, Taipei,
Taiwan. E-mail: [email protected]
0041-1345/08/$–see front matter
doi:10.1016/j.transproceed.2008.07.097
© 2008 by Elsevier Inc. All rights reserved.
360 Park Avenue South, New York, NY 10010-1710
2844
Transplantation Proceedings, 40, 2844 –2845 (2008)
HEART TRANSPLANTATION IN L-TGA
2845
defects of the systemic ventricles with right ventricular
morphology.5 Because of the abnormal alignment of the
great arteries in L-TGA, the transplantation required
technical modifications. Reitz et al at Stanford University
Medical Center first reported a successful HTx for
corrected TGA in 1982.6 Since then, only a few cases
have been reported in the literature.1–3 During removal
of the donor heart, the arch is fully dissected to obtain
extra length. We suggest removing the whole aortic arch
together with the branches so that we do not have to use
a vascular prosthesis. After completion of the anastomosis, some clockwise rotation of the donor heart is acceptable. There was no compromise in hemodynamics after
HTx.
In conclusion, HTx for corrected transposition of the
great arteries is technically feasible. Preservation of aortic
arch of the donor heart may be necessary to achieve a good
anatomic correction. The long-term results of this operation are as good as other HTx procedures.
REFERENCES
Fig 1. Completion of heart transplantation: note clockwise
rotation of the heart.
of the aortic arch were suture-ligated to extend the length of the
aorta (Fig 1).
The postoperative course was uneventful. He was discharged
from the hospital at 20 days after the operation. Follow-up
echocardiography and coronary artery angiography were normal.
He did not experience rejection and is doing well in posttransplant
year 4.
DISCUSSION
Patients with unoperated L-TGA show a high prevalence
of heart failure, partly due to myocardial perfusion
1. Harjula ALJ, Heikkila LJ, Nieminen MS et al: Heart transplantation in repaired transposition of the great arteries. Ann
Thorac Surg 46:611, 1998
2. Jebara VA, Dreyfus G, Acar CC, et al: Heart transplantation
for corrected transposition of the great vessels. J Cardiac Surg
5:102, 1990
3. Blanche C, Valenza M, Czer LS, et al: Heart transplantation
in corrected transposition of the great arteries. J Heart Lung
Transplant 13:631, 1994
4. Taylor DO, Edwards LB, Boucek MM, et al: Registry of the
International Society for Heart and Lung Transplantation: twentyfourth official adult heart transplant report—2007. J Heart Lung
Transplant 26:769, 2007
5. Hornung TS, Bernard EJ, Jaeggi ET, et al: Myocardial
perfusion defects and associated systemic ventricular dysfunction in
congenitally corrected transposition of the great arteries. Heart
80:322, 1998
6. Reitz BA, Jamieson SW, Gaudiani VA, et al: Method for
cardiac transplantation in corrected transposition of the great
arteries. J Cardiovasc Surg (Torino) 23:293, 1982