THE SURGICAL ANASTOMOSES AFTER ORTHOTOPIC HEART-TRANSPLANTATION - CLINICAL COMPLICATIONS AND MORPHOLOGIC OBSERVATIONS

From May 1984 through June 1993, 162 patients have undergone orthotopi c heart transplantation at the University of Ottawa Heart Institute. T hirty-three deaths occurred, and postmortem examinations were performe d in 29 of these cases. This study evaluated the surgical anastomoses of these patients' hearts, an aspect of orthotopic heart transplantati on that has not been well described in the literature. The major findi ngs encountered were two cases of stenosis at the left atrial anastomo sis, one case of aortic anastomotic tear, one case of pulmonary artery anastomotic kinking, one case of left atrial suture line mural thromb us and possible coronary embolism, and one case of extramural compress ion of a coronary artery by an anastomotic suture. Other findings when the suture lines were examined included residual native valve remnant s, protruding tissue tags or other tissue remnants, mural thrombi, and protruding free suture ends. These findings are described, illustrate d, and discussed in the context of the published literature on the sub ject.