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J Thorac Cardiovasc Surg 1998;116:82-86
© 1998 Mosby, Inc.

Cardiothoracic Transplantation

Heart transplantation in infants and children with situs inversus

From the Divisions of Cardiothoracic Surgery^a and Pediatric Cardiology,^b Loma Linda University Medical Center and Children's Hospital, Loma Linda, Calif.

Received for publication Sept. 16, 1997. Revisions requested Nov. 4, 1997. Revisions received Feb. 13, 1998. Accepted for publication Feb. 13, 1998. Address for reprints: Loma Linda University Medical Center, 11175 Campus St., Suite 21120, Loma Linda, CA 92354.

Background: Recipient situs inversus has always represented a technical challenge during heart transplantation.
Objective: A simplified operative strategy for heart transplantation in a recipient with atrial situs inversus is described.
Methods: Fifteen pediatric recipients with situs inversus accompanying other complex congenital heart disease or dilated cardiomyopathy having "orthotopic" heart allotransplantation in one center, between 1985 and 1997, were reviewed retrospectively. A nearly uniform, simplified technical approach to transplantation was used and is described.
Results: Fourteen of these recipients with complex malformations survived the transplantation. Morbidity relating to surgical technique has been limited to partial (n = 2) or complete (n = 1) late obstruction of superior vena caval drainage; each case was managed successfully by interventional cardiologic techniques. Actuarial survival after transplantation compares favorably with that among 290 infants and children with atrial situs solitus who underwent heart transplantation.
Conclusions: Systemic atrial malposition, including situs inversus, does not limit successful heart transplantation by the simplified method described.

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