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J Thorac Cardiovasc Surg 2007;134:543-544
© 2007 The American Association for Thoracic Surgery

Brief Communication

Heart–lung transplantation in a patient with large aortopulmonary collaterals by means of an extended approach

Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.

Received for publication January 12, 2007; accepted for publication January 23, 2007.

^_* Address for reprints: Klaus Kallenbach, MD, University Hospital Heidelberg, Department of Cardiac Surgery, INF 110, D-69120 Heidelberg, Germany. (Email: klaus.kallenbach@med.uni-heidelberg.de).

The first 20% of the full text of this article appears below.

For combined heart–lung transplantation, median sternotomy represents the standard approach, allowing exposure of the ascending aorta, both caval veins, and the distal trachea.¹ However, aortopulmonary collaterals at the dorsal aspect of pulmonary vessels cannot be reached. Here we report of an innovative approach combined with atypical cannulation for cardiopulmonary bypass (CPB) to control severe aortopulmonary collaterals in a patient requiring combined heart–lung transplantation after multiple congenital heart operations.

Clinical Summary

A 25-year-old female patient presented with congestive heart failure of New York Heart Association class IV, vertigo, and central cyanosis. She was born with atresia of the pulmonary artery, a high ventricle septal defect, and multiple aortopulmonary collaterals, and she was operated on several times for re-establishment of pulmonary circulation: placement of a right-sited modified Blalock–Taussig shunt and unifocal attachment of a bronchial collateral vessel, resection of the infundibulum, and connection of the right ventricle to the pulmonary artery combined with closure of a ventricular septal defect and placement of a Blalock–Taussig shunt. Postoperative arterial pulmonary hypertension required reopening of the ventricular septal defect and banding . . . [Full Text of this Article]

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