Bicaval orthotopic heart transplantation in a patient with persistent left superior vena cava

Commentary: Double your fun? Management of persistent left superior vena cava during transplantation

“…As the recipient heart is excised, careful and meticulous dissection is performed of the coronary sinus, preserving its continuity to the PLSVC such that it may either rest in situ or serve as a conduit for reconstruction to the donor RSVC. Previously described by Tanaka and colleagues 1 with anastomosis of this conduit to the donor right atrial appendage freed of pectinate muscle attachments, this technique allows for autologous tissue reconstruction, which can be particularly helpful in young children still undergoing somatic growth. Tanaka and colleagues 1 specifically detail use of a suction drainage tube in the coronary sinus as a reference stent as well as meticulous detail to coronary sinus bleeding from coronary vein branches upon completion of transplantation.…”

“…Previously described by Tanaka and colleagues 1 with anastomosis of this conduit to the donor right atrial appendage freed of pectinate muscle attachments, this technique allows for autologous tissue reconstruction, which can be particularly helpful in young children still undergoing somatic growth. Tanaka and colleagues 1 specifically detail use of a suction drainage tube in the coronary sinus as a reference stent as well as meticulous detail to coronary sinus bleeding from coronary vein branches upon completion of transplantation. Herein, the authors describe anastomosis to the donor RSVC.…”

“…Maintenance of the coronary sinus connection is also performed while leaving the coronary sinus in situ as a biatrial transplant or an extended inferior vena cava (IVC) anastomosis incorporating both recipient IVC as well recipient coronary sinus en-bloc into the donor IVC. 1 , 2 , 3 , 4 This technique minimizes manipulation of the coronary sinus, which can mitigate bleeding or torsion. A unique situation is one in which the coronary sinus is unroofed or fenestrated to the left atrium and hence complex intracardiac baffle is required to redirect coronary sinus blood to the right atrium.…”