Cardiac transplantation in situs inversus: two cases reports

Area of Science:

• Cardiology
• Congenital Heart Disease
• Surgical Innovation

Background:

• Surgical reconstruction of systemic venous return is a critical challenge in heart transplantation for patients with situs inversus.
• Situs inversus, a condition where visceral organs are mirrored, complicates standard surgical procedures.
• Complex congenital heart disease often coexists with situs inversus, further increasing surgical difficulty.

Observation:

• Two cases of complex congenital heart disease with atriovisceral situs inversus undergoing heart transplantation are presented.
• Both patients exhibited similar cardiac anomalies, including a single ventricle, a single atrioventricular (AV) valve with severe regurgitation, and severe pulmonary stenosis.
• The surgical team employed two distinct methods for reconstructing the systemic venous return.

Findings:

• In the first case, the donor inferior vena cava (IVC) was directly anastomosed to the recipient's left-sided IVC, resulting in slight counterclockwise cardiac rotation.
• The second case utilized a composite conduit, constructed from the recipient's right atrium, to achieve IVC venous reconnection.
• Both strategies successfully addressed the complex venous anomalies associated with situs inversus.

Implications:

• These cases demonstrate adaptable surgical techniques for managing systemic venous return in heart transplantation for patients with situs inversus and complex congenital heart disease.
• Successful venous reconstruction can be achieved through direct anastomosis or the use of autologous grafts, offering flexibility in surgical planning.
• Further research into optimizing these techniques could improve outcomes for this challenging patient population.