Cardiac Auto Transplantation (The procedure of explantation and reimplantation of the heart)
A 55 years old patient admitted to our hospital with a size of 25x20 left atrium, a severe mitral valve disease. The symptoms of the disease were pulmonary edema, asthma, low cardiac output, arrhythmia, extreme fatigue and abnormal weight loss. In order to contract the left atrium, a cardiac autotransplantation surgery, the procedure of explantation and reimplantation of the heart was performed on the patient.
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cardiological examination was made on the patient who came to our
hospital with severe health problems such as asthma, acedia,
tachycardia and paleness of the skin. The patient had an ordinary
life before these symptoms but after having these kind of serious
health problems the patient decided to have an examination.
As a result of these examinations, it was seen that the mitral valve was narrowed and left atrium was enlarged in an extreme way. The enlargement of the left atrium was 25x20 cm and it was making a pressure on surrounding tissues, right atrium, thoracic cage, surrounding veins and the patient had a severe pulmonary edema. As a result, the heart no longer fitted into the thoracic cage.
In the lung x-rays the heart was surrounding all of the thoracic cage. In the finding of echocardiography, left atrium was so large and there was mitral insufficiency.
After the hospitalization of the patient the strategy of the surgery was planned and the patient was informed about the details and the risk of the surgery. After that the patient was taken into the operation. The principle objective of the operation was to respond mitral valve and effectively to reduce the giant left atrium.
In these kind of cardiac dilatation surgeries where the dilatation effects all the molds in the thoracic cage as it is so large, we use heart and lung machine during the surgery. The body is entirely connected to the machine and it provides the circulation of the body. In this way, heart and lung stops temporarily still all the organs and their functions are protected.
The left atrium covers the back wall of the heart completely so it is almost impossible to open the heart from one side and reduce the left atrium effectively. For this reason we decided to perform the surgery with Cardiac Autotransplantation technique. The heart was excised as it should be, the left atrium was reduced, the mitral valve was replaced and the heart was reimplanted to the cardiac cavity. As the heart was bigger before the surgery, in order to adapt the cardiac cavity to the small heart , cardiac membrane was also reduced so they perfectly adapt each other. The damages of the enlargement of the heart to the other parts were also recovered. The right atrium had reduced as size because of the pressure of the big left atrium so with the new cardiac membrane another right atrium was made for the patient.
The patient had arrhythmia before the surgery but after the reimplantation of the heart with the air extraction we provided blood flow so the the rthym of the heart is balanced.
As the left atrium and the heart were taken out completely from the body, it enabled the ablation (Box-Lesion). That is to say the damaged transmission system of the heart because of the cardiac dilatation, returned back to normal.
The patient did not have any complications after the surgery and he was discharged on 12. postoperative day in good conditions.
Cardiac auto transplantation surgery, the procedure of explantation and re-implantation of the heart is one of a rare cardiac surgeries. It was only performed a couple of times for cardiac dilatation or tumors. Generally people think that in all cardiac surgeries the heart is taken from the body and refitted at the end of the surgery. But it is not true. For the cardiac auto transplantation surgeries it is true, but this is a kind of operation which is difficult and rare as a result, can only be performed on specific patients.
In literature, the mortality of this surgery is between 25% and 75%. However, as it is a rare operation, it is not possible to get an accurate statistics to verify these rates. (Lit 1).
1) Shanda H., Blackmon MD, Michale JR. Cardiac Autotransplantation, Operative Techniques in Thoracic and Cardiovascular Surgery, Volume 15 Issue 2, Summer 2010, Pages 147 - 161