Orthotopic heart transplantation with preoperative unsuspected left superior vena cava and absence of right superior vena cava

We report the case history of a 47-year-old man who underwent orthotopic heart transplantation for ischemic cardiomyopathy. At the time of cardiectomy, the patient was found to have a persistent left superior vena cava draining into the coronary sinus and complete absence of his right superior vena cava. The donor heart had been removed without knowledge of this venous anomaly; consequently, the donor's superior vena cava and innominate vein were not harvested. The persistent left superior vena cava was cannulated for cardiopulmonary bypass. The recipient's heart was excised along the atrial ventricular groove, preserving the persistent left superior vena cava and coronary sinus. The atrial cuffs of the recipient and donor were fashioned for atrial-to-atrial anastomoses. Successful endomyocardial biopsies have been performed through the femoral veins after transplantation.