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CT of Two Hearts Beating in One Chest

¹ Department of Medical Imaging, Far Eastern Memorial Hospital, Taipei, Taiwan.
² Department of Radiology, China Medical University Hospital, Taichung, Taiwan.
³ Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, No. 21, Nan-Ya S Rd. Sec. 2, Pan-Chiao, Taipei 220, Taiwan.
⁴ Department of Cardiology, Far Eastern Memorial Hospital, Taipei, Taiwan.
⁵ Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan.

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —56-year-old man with ischemia and cardiomyopathy. Heterotopic heart transplantation was performed 6 years earlier. dAorta = aorta of donor heart, dPA = main pulmonary arteries of donor heart, dRV = right ventricle of donor heart, dLV = left ventricle of donor heart, dRA = right atrium of donor heart, rRA = right atrium of recipient heart, rRV = right ventricle of recipient heart, DG = polyester textile fiber (Dacron, DuPont) tube graft. Heterotopic heart transplant is shown by 3D volume rendering (VR) reconstructed by cardiac CT. VR image shows relationship between donor and recipient hearts.

View larger version (54K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —56-year-old man with ischemia and cardiomyopathy. Heterotopic heart transplantation was performed 6 years earlier. dAorta = aorta of donor heart, dPA = main pulmonary arteries of donor heart, dRV = right ventricle of donor heart, dLV = left ventricle of donor heart, dRA = right atrium of donor heart, rRA = right atrium of recipient heart, rRV = right ventricle of recipient heart, DG = polyester textile fiber (Dacron, DuPont) tube graft. Schematic diagram of heterotopic heart transplant. For heterotopic heart transplantation, native heart remains in situ and new heart is added to right side of native heart. Anastomoses between right atrium, left atrium, main pulmonary arteries with a tube graft, and aortas are shown.

View larger version (23K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —Schematic of heterotopic heart transplantation shows anastomoses and blood flow (arrows) in native and donor hearts. RA and LA indicate right and left atria, respectively; RV and LV, right and left ventricles; PA, pulmonary artery; Ao, aorta; SVC, superior vena cava; PV, pulmonary vein; and dotted lines, polyester textile fiber (Dacron, DuPont) tube graft.

View larger version (153K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —56-year-old man with ischemia and cardiomyopathy. Heterotopic heart transplantation was performed 6 years earlier. Same patient is shown in Figures 1A and 1B. Coronal oblique CT image shows normal aortic anastomosis (long arrow). Short arrow shows left anterior descending coronary artery of recipient heart. rAo = aorta of recipient heart, dAo = aorta of donor heart.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —56-year-old man with ischemia and cardiomyopathy. Heterotopic heart transplantation was performed 6 years earlier. Same patient is shown in Figures 1A and 1B. Axial CT image shows normal left atrial anastomosis (arrow). Old infarction with calcification in septal and apical walls of recipient left ventricle is noted. Also seen is regional wall motion abnormality. dAo = aorta of donor heart, dLA = left atrium of donor heart, rLA = left atrium of recipient heart, rLV = left ventricle of recipient heart.

View larger version (155K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —53-year-old man with ischemia and cardiomyopathy. Heterotopic heart transplantation was performed 2 years earlier. dLA = left atrium of donor heart, rLA = left atrium of recipient heart. Axial cardiac CT image shows stenotic left atrial anastomosis (arrow) that is 0.8 cm in diameter.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —53-year-old man with ischemia and cardiomyopathy. Heterotopic heart transplantation was performed 2 years earlier. dLA = left atrium of donor heart, rLA = left atrium of recipient heart. Volume-rendering image shows stenotic anastomosis (arrows) of left atria.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —53-year-old man with ischemia and cardiomyopathy. Heterotopic heart transplantation was performed 2 years earlier. Same patient is shown in Figures 4A and 4B. Surgical anterior ventricular endocardial restoration was performed for apical aneurysm due to old left ventricle infarction. Arrowhead shows surgical patch of left ventricle. Leakage (short arrow) is indicated in lateral aspect of left ventricle. In addition, small residual apical aneurysm (long arrow) is noted.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —56-year-old man with ischemia and cardiomyopathy. Heterotopic heart transplantation was performed 6 years earlier. Same patient is shown in Figures 1A, 1B, 3A, and 3B. rAo = aorta of recipient heart. Axial CT image shows patent metallic stent (arrow) in polyester textile fiber (Dacron, DuPont) tube graft connecting recipient and donor main pulmonary arteries. rPA = main pulmonary artery of recipient heart.

View larger version (159K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —56-year-old man with ischemia and cardiomyopathy. Heterotopic heart transplantation was performed 6 years earlier. Same patient is shown in Figures 1A, 1B, 3A, and 3B. rAo = aorta of recipient heart. Oblique coronal CT view shows round shape of stent (arrow) in Dacron tube graft without deformation.

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —56-year-old man with ischemia and cardiomyopathy. Heterotopic heart transplantation was performed 6 years earlier. Same patient is shown in Figures 1A, 1B, 3A, and 3B. rAo = aorta of recipient heart. Axial (C) and oblique coronal (D) CT images show intraluminal mural thrombus (arrow) with approximately 50% stenosis in main pulmonary artery of donor heart.

View larger version (176K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D —56-year-old man with ischemia and cardiomyopathy. Heterotopic heart transplantation was performed 6 years earlier. Same patient is shown in Figures 1A, 1B, 3A, and 3B. rAo = aorta of recipient heart. Axial (C) and oblique coronal (D) CT images show intraluminal mural thrombus (arrow) with approximately 50% stenosis in main pulmonary artery of donor heart.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —52-year-old man with ischemia and cardiomyopathy. Heterotopic heart transplantation was performed 7 years earlier. Curved multiplanar reconstruction (MPR) of CT image shows normal left anterior descending (LAD) artery and concentric noncalcified plaque (arrowheads) with insignificant stenosis in proximal left circumflex coronary artery of donor heart.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —52-year-old man with ischemia and cardiomyopathy. Heterotopic heart transplantation was performed 7 years earlier. MPR of CT image shows diffuse eccentric calcified plaques in proximal and middle right coronary artery of recipient heart with insignificant stenosis.

View larger version (94K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8 —53-year-old man with ischemia and cardiomyopathy. Heterotopic heart transplantation was performed 2 years earlier. Same patient is shown in Figures 4A, 4B, and 5. Curved multiplanar reconstruction of CT image shows in-stent total occlusion of left anterior descending artery (LAD) of recipient heart (arrow). Chronic total occlusion (arrowheads) is also noted distal to metallic stent. Contrast enhancement of distal LAD is due to reversed blood flow.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —52-year-old man with ischemia and cardiomyopathy. Heterotopic heart transplantation with two coronary artery bypass grafts (CABG) was performed 7 years earlier. Same patient is shown in Figures 7A and 7B. Three-dimensional volume-rendering image shows one CABG (arrows) from right aspect of aorta to posterior descending artery (PDA) and other CABG (arrowheads) from anterior aorta to left anterior descending artery.

View larger version (159K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —52-year-old man with ischemia and cardiomyopathy. Heterotopic heart transplantation with two coronary artery bypass grafts (CABG) was performed 7 years earlier. Same patient is shown in Figures 7A and 7B. Curved multiplanar reconstruction shows patent graft vessel from aorta of recipient heart to PDA (arrow).

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10 —45-year-old man with dilated cardiomyopathy. Heterotopic heart transplantation was performed 4 months earlier. Axial CT image shows compression of right middle lung by donor heart (arrows). dPA = main pulmonary arteries of donor heart, rRV = right ventricle of recipient heart, rAo = aorta of recipient heart.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11 —53-year-old man with ischemia and cardiomyopathy. Heterotopic heart transplantation was performed 2 years earlier (same patient is shown in Figs. 4A, 4B, 5, and 8). Axial CT image shows bilateral pleural effusions with adjacent pulmonary atelectasis.

View larger version (59K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12 —60-year-old man with ischemia and cardiomyopathy. Heterotopic heart transplantation was performed 11 years earlier. Axial CT image shows 4-cm mass (arrow) in left upper lung with lymphadenopathy in mediastinum (arrowhead). Non–small cell lung carcinoma was proven by bronchoscopic biopsy.

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