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J Thorac Cardiovasc Surg 2002;123:374-376
© 2002 The American Association for Thoracic Surgery

Brief Communications

Backtable ventricular and atrial septal defect repair of an Eisenmenger allograft with concomitant domino heart transplantation

M. Gorlitzer, MDa, H. J. Ankersmit, MDa, G. Wollenek, MDa, W. Wisser, MDa, G. Wieselthaler, MDa, M. Haisjacklb, R. Horvat, MDc, H. Gabriel, MDd, E. Wolner, MDa, M. Grimm, MDa Vienna, Austria

From the Departments of CT Surgery,a Anaesthesiology,b Pathology,c and Internal Medicine,d General Hospital Vienna, Vienna, Austria.

Received for publication July, 18, 2001. Accepted for publication July 25, 2001. Address for reprints: Michael Gorlitzer, MD, Department of CT Surgery, General Hospital Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria (E-mail: michael.gorlitzer@hotmail.com).

Allograft scarcity limits the clinical application of allograft transplantation. Domino heart transplantation has been described as a feasible option in acquiring additional heart allografts.Go 1 New descriptive operative techniques and options in widening the donor pool are, however, limited in the recent literature. We are presenting the case of a patient who had pulmonary hypertension because of uncorrected persistent atrial and ventricular septal defects (ASD, VSD) and therefore was not suitable for primary heart transplantation. This patient underwent combined heart-lung transplantation after 11 months on the waiting list. The autochthonous heart with the ASD and VSD was replaced, surgically repaired in a backtable maneuver, and transplanted into a patient in New York Heart Association class IV.

Yacoub and others demonstrated in their transplant programs that domino cardiac transplantation is a successful and feasible option for acquiring additional allografts with results comparable to those of conventional allotransplantation.Go Go 2-4 In domino cardiac transplantation, usually the normal heart of a heart-lung transplant recipient is implanted into another recipient with end-stage heart failure. In addition to this previously described surgical scenario, we are reporting that an allograft that caused the Eisenmenger syndrome in the heart-lung recipient was repaired in a backtable procedure and successfully implanted as an allograft. A pathophysiological discussion is also included.

Clinical summary
Heart-lung recipient
A 48-year-old woman with severe pulmonary hypertension resulting from a perimembranous VSD (18 mm in diameter) and a persistent oval foramen with Eisenmenger syndrome was evaluated for heart-lung transplantation. The cardiac disease had been diagnosed at 27 years of age. The symptoms became severe 1 year before transplantation (New York Heart Association class III-IV). Right heart catheterization revealed a . . . [Full Text of this Article]






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