Teaching Case

We report a case of a young man who was diagnosed with severe dilated cardiomyopathy at the age of only 12 years. A heterotopic heart transplant was done at the age of 16 years with a donor heart from a 9-year-old to support the failing native heart.

The donor superior vena cava (SVC) was anastomosed to the recipient SVC. The donor right ventricle (RV) was anastomosed to the native right atrium. The donor left atrium was anastomosed with the native left atrium creating a very large common left atrium. The proximal donor ascending aorta was joined to the proximal recipient thoracic aorta.

Heterotopic heart transplant is a life-saving procedure for use in urgent cases when the only donor heart available is too small for orthotopic transplant [1, 2]. The donor heart is transplanted alongside the recipient’s heart and the native heart takes on an “assist device” role, contributing to the total cardiac output, particularly when there is a mismatch between the patient’s heart and donor heart size. Another advantage being that the native heart acts as an auxiliary pump during episodes of acute rejection [3]. Heterotopic heart transplant may significantly increase the size of the donor pool and decrease the waiting time particularly in case of recipient’s heart with a potential of recovery or when the recipient-donor heart size mismatch is substantial [4, 5].

We present a 21 year follow-up of a young man in whom a heterotopic heart transplant was performed in the presence of donor-recipient size mismatch and a compromised native heart.

A young boy was diagnosed with severe dilated cardiomyopathy at the age of 12 years. He underwent a heterotopic heart transplant 21 years ago when he was just 16 years old. The donor heart was from a 9 year old child.

The donor SVC was anastomoses to the recipient SVC. The donor RV was anastomosed to the native right atrium. The donor left atrium was anastomosed with the native left atrium creating a very large common left atrium. The proximal donor ascending aorta was joined to the proximal recipient thoracic aorta. The further course was uneventful and the boy showed a normal mental and somatic growth.

In 1998, the young man suffered from a CVA and made an unremarkable recovery. In 2016, the man was admitted in the hospital for fluid overload. The man made a good recovery. During his short hospital stay moderate aortic regurgitation was detected in the native heart, however, the donor heart showed good LV and RV systolic function. He is on a regular follow-up and there is a plan to assess him for TAVI suitability in the future.
Today, the man is enjoying an active life and is a father of a lovely daughter.