Using donor ascending aorta for venous reconstruction in a situs inversus heart transplantation

Abstract

A 66-year-old female was a case of situs inversus that developed heart failure. Heart transplantation was performed with the modified method. While we harvested the donor's heart, we left an extra-aortic conduit in the ascending aorta. Donor's superior vena cava (SVC) and inferior vena cava were also retained for available anastomoses to the systemic venous return of the recipient. The donor's right atrium (RA) and lower half of the recipient's RA were connected using a 4-cm long conduit (from the retained aortic segment). The donor's SVC was anastomosed to the upper half of the recipient's RA. We placed a titanium vascular ring around the donor's SVC between the aorta and pulmonary artery (PA). In the present case, we preserved the extra-aortic conduit for reconstruction of the venous return system. The allogeneic aortic conduit had the advantage that it could avoid external compression and may have prevented thrombosis in anastomoses between the vena cava and atrium. A titanium ring could maintain the donor's SVC that passed through the aorta and PA. Future efforts should be directed to follow the patency of the venous pathway.