Orthotopic heart transplantation in a patient with D-transposition of the great arteries: after a Mustard procedure.

During heart transplantation, the atrial septum is most often used to reconstruct the right atrial reservoir. We report the case of a patient with corrected D-transposition of the great arteries who underwent successful cardiac transplantation despite the lack of an atrial septum. We then used the donor heart's atrial septum for the roof of the left atrium and used the recipient's left atrium for the back wall of the left atrium. The outcome was a more anatomically positioned transplanted heart, which avoided the duplication of the right and left atria that occurs in conventional orthotopic transplantation and that often leads to left-lower-lobe atelectasis and tricuspid regurgitation. This method of orthotopic transplantation should be considered for, but not limited to, the growing number of adults with congenital heart disease who require heart transplantation.