JACC. Case reports · 2025
Cardiac Transplantation in a Patient With Situs Inversus Totalis and Extracardiac Fontan.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Dani Abas, Bouhout Ismail, Poirier Nancy, Noly Pierre-Emmanuel
Аннотация
OBJECTIVE: This case report describes a successful dextrocardia-preserving orthotopic heart transplant in a patient with situs inversus totalis and an extracardiac Fontan, utilizing a levocardia donor heart.
KEY STEPS: The donor heart was rotated 90° counterclockwise along its longitudinal axis to optimize inferior venous connection and incorporate existing extracardiac Fontan. Superior venous connections were secured using a harvesting technique preserving the innominate vein. A GORE-TEX graft was wrapped around the innominate vein to prevent its compression as it passed through the aortic arch.
POTENTIAL PITFALLS: Counterclockwise rotation requires adequate pulmonary artery length. In the absence of extra aortic tissue to allow mild aortic bowing and prevent superior venous obstruction, a GORE-TEX graft offers an effective alternative to maintain unobstructed superior venous drainage.
TAKE-HOME MESSAGES: Dextrocardia-preserving transplantation is feasible with a 90° counterclockwise rotation. Reusing the extracardiac Fontan reduces ischemic time; reinforcing the innominate vein with GORE-TEX prevents compression, securing venous integrity.
KEY STEPS: The donor heart was rotated 90° counterclockwise along its longitudinal axis to optimize inferior venous connection and incorporate existing extracardiac Fontan. Superior venous connections were secured using a harvesting technique preserving the innominate vein. A GORE-TEX graft was wrapped around the innominate vein to prevent its compression as it passed through the aortic arch.
POTENTIAL PITFALLS: Counterclockwise rotation requires adequate pulmonary artery length. In the absence of extra aortic tissue to allow mild aortic bowing and prevent superior venous obstruction, a GORE-TEX graft offers an effective alternative to maintain unobstructed superior venous drainage.
TAKE-HOME MESSAGES: Dextrocardia-preserving transplantation is feasible with a 90° counterclockwise rotation. Reusing the extracardiac Fontan reduces ischemic time; reinforcing the innominate vein with GORE-TEX prevents compression, securing venous integrity.