Orthotopic heart transplantation with persistent left superior vena cava draining into coronary sinus: the anterior rero
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ORIGINAL ARTICLE
Orthotopic heart transplantation with persistent left superior vena cava draining into coronary sinus: the anterior rerouting technique Yojiro Koda1 · Hidefumi Nishida1 · Valluvan Jeevanandam1 · Takeyoshi Ota1 Received: 29 July 2020 / Accepted: 25 September 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Background We present a surgical technique for a reconstruction of a persistent left superior vena cava draining into the coronary sinus with orthotopic heart transplantation. Methods Between January 2013 and July 2019, a total of 224 patients underwent orthotopic heart transplantation in our institution. Among them, three patients (3/224, 1.3%) had a persistent left superior vena cava draining into the coronary sinus. The persistent left superior vena cava and the coronary sinus was isolated and fully mobilized as an en bloc conduit at the time of explanting the heart. After the standard anastomoses using the bicaval technique, the conduit was routed anterior to the great vessels and anastomosed to the right atrial appendage. A smooth venous drainage into the right atrium from the rerouted persistent left superior vena cava was intraoperatively confirmed by transesophageal echocardiography. Results The postoperative course was uneventful in all patients. There were no major postoperative complication and inhospital mortality. The routed persistent left superior vena cava-coronary sinus conduits were confirmed to be patent without stenosis/obstruction by an enhanced computed tomography. Cardiac biopsies through the reconstructed persistent left superior vena cava were possible without any difficulty. Conclusion The anterior rerouting technique for a reconstruction of a persistent left superior vena cava draining into the coronary sinus in an orthotopic heart transplantation was feasible and reproducible. Keywords Orthotopic heart transplantation · Persistent left superior vena cava · Anterior rerouting technique
Introduction The prevalence of persistent left superior vena cava (PLSVC) is 0.5% in the general population [1], and 90% of PLSVCs drain into a coronary sinus (CS) [2]. PLSVC draining into the CS is a benign anatomic anomaly. However, it must be addressed during heart transplantation when the recipient has a PLSVC without a bridging vein or with a hypoplastic right superior vena cava (RSVC) to reroute venous drainage into the right atrium of the donor heart.
This study was presented at The 72th Annual Scientific Meeting of The Japanese Association for Thoracic Surgery. * Takeyoshi Ota [email protected] 1
Department of Surgery, Section of Cardiac and Thoracic Surgery, Center for Aortic Diseases, The University of Chicago Medicine, 5841 S Maryland Avenue, MC5040, Chicago, IL 60637, USA
We have developed a novel technique for reconstruction of a PLSVC during an orthotopic heart transplantation (OHT). In this study, we present three cases where the technique was employed.
Patients and methods Between January 2013 and July 2019, a total of 224 patients und
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