Heterotopic heart transplantation--a life-saving procedure with a size-mismatched donor

A 32-year-old B-type male weighing 60 kg suffered from end-stage dilated cardiomyopathy. Although aggressive medical treatment with dobutamine 21 micrograms/kg/min, dopamine 17 micrograms/kg/min, digoxin 0.25 mg i.v. once daily, furosemide 40 mg i.v. every 6 h, and bumetanide 0.5 mg i.v. every 6 h were given, he was finally ventilator dependent for the last 3 weeks until a B-type donor weighing 42.5 kg was found. Because of the 29.2% weight mismatch, a heterotopic heart transplantation was performed. Posterior plication mitral annuloplasty was also performed to correct the severe mitral regurgitation of the recipient heart. Postoperatively the patient remained respirator dependent for 17 days and was finally discharged in good condition on the 46th postoperative day.