Three cases of orthotopic cardiac transplantation for congenital dextrocardia

Objective To summarize the surgical strategies of orthotopic cardiac transplantation for congenital dextrocardia. Methods Three patients with congenital dextrocardia suffered from end-stage heart failure and underwent orthotopic cardiac transplantation from March 2014 to September 2017. They were aged 10, 29, 13 years respectively. Donor hearts were from brain death donors and procured with extra length on inferior vena cava, aorta and pulmonary artery tissues. After cardiectomy, left atrial-atrial anastomosis was performed initially between donor’s left-upper pulmonary vein orifices and recipient’s left-lower pulmonary vein orifices. Apex was orientated at a 90 degrees’ clockwise to right. Then aorta, inferior and superior vena cava and last pulmonary artery were anastomosed continuously. The prosthetic conduits were also used owing to a lack of tissue. Results All operations were successful. The cold ischemic time was (130-375)(251.00±122.53) min, cardiopulmonary bypass time (127-212)(179.67±55.72) min and aortic clamp time (38-105)(65.33±35.166) min. Two patients had stable hemodynamics and recovered well after HTx. During a follow-up period of 1.5-3.5 years, echocardiography showed excellent cardiac functions without blood flow obstruction. Chest radiology showed well-placed donor heart in right mediastinum. One left-sided patient with total cavopulmonary connection before HTx died at 59 days after HTx because of pneumonia and multiple organ failure. Conclusions Heart transplantation is curative for patients with congenital dextrocardia and surgical strategies are the key factor of successful treatment. Key words: Congenital heart disease; Dextrocardia; Heart transplantation