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Fig. 13A.1. Cardiac Transplantation for Hypoplastic Left Heart Syndrome, (HLHS) Can-nulation and Cardiectomy. The main pulmonary artery (MPA) is cannulated for arterial inflow, with the branch pulmonary arteries controlled with tourniquets. Systemic perfusion is through the ductus arteriosus and blood flow in the ascending aorta (Ao) is retrograde. The superior vena cava (SVC) and inferior vena cava (IVC) are cannulated for the venous return. Note the diminutive left ventricle (LV) and dominant right ventricle (RV). The second panel shows the recipient heart excised leaving the posterior right atrium (RA), atrial septal defect (ASD), and left atrium (LA). Systemic perfusion is being maintained.

Fig. 13A.1. Cardiac Transplantation for Hypoplastic Left Heart Syndrome, (HLHS) Can-nulation and Cardiectomy. The main pulmonary artery (MPA) is cannulated for arterial inflow, with the branch pulmonary arteries controlled with tourniquets. Systemic perfusion is through the ductus arteriosus and blood flow in the ascending aorta (Ao) is retrograde. The superior vena cava (SVC) and inferior vena cava (IVC) are cannulated for the venous return. Note the diminutive left ventricle (LV) and dominant right ventricle (RV). The second panel shows the recipient heart excised leaving the posterior right atrium (RA), atrial septal defect (ASD), and left atrium (LA). Systemic perfusion is being maintained.

a median sternotomy, usually as part of a multi-organ harvest. The donor is anti-coagulated with 300 units/kg of heparin intravenously. The donor heart is arrested and preserved with cold crystalloid cardioplegia (30 cc/kg), infused under careful low pressure injection. For patients with HLHS, the entire donor aortic arch is harvested. For recipients with complex caval or pulmonary artery anatomy the innominate vein and/or right and left pulmonary arteries are also harvested with the donor. We attempt to keep the total donor ischemia time under four hours.

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