Orthotopic heart transplantation with persistent left superior vena cava draining into coronary sinus: the anterior rerouting technique

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.

Perioperative Management of a Donation After Circulatory Death Heart Transplant in a Recipient With a Persistent Left Superior Vena Cava

“…While PLSVC is a common congenital venous abnormality, it only occurs in about 0.5% of the normal population [1][2][3][4][5][6]. Some evidence can suggest the presence of a PLSVC prior to surgery, such as mediastinal widening or an abnormally positioned CVC on chest X-ray; however, there was no indication of a PLSVC seen in this patient's preoperative workup [5,[8][9].…”

“…Thus, these anatomical abnormalities were found intraoperatively after a DCD heart transplantation was planned. Surgery proceeded using a bicaval technique and a size 16 aortic graft to anastomose the PLSVC to the R atrial appendage [1,3,[5][6]. Upon noting the patient's small R SVC, a size 14 interposition graft was added to complete the anastomoses.…”

“…Persistent left superior vena cava (PLSVC) is a common congenital venous abnormality, with an overall prevalence of 0.3% to 0.5% [1][2][3][4][5][6]. Prevalence in patients with congenital heart disease is 2.8% to 4.3% [1][2][3][4][5].…”