CT-guided biopsy in heterotopic heart transplant: A case report

Background: Heterotopic heart transplantation is a surgical technique that has not been embraced broadly. In this historic technique, the donor heart is sutured in parallel to the recipient heart with both hearts in place. Case summary: We report a patient who received a heterotopic heart transplant at our institution more than 15 years ago with preserved cardiac function and who needed a myocardial biopsy due to heart failure symptoms. Due to complex anatomy, a cardiac computed tomography imaging reconstruction was used to create a live roadmap overlay on fluoroscopy during myocardial biopsy. Such a technique facilitated obtaining a biopsy successfully and safely to rule out rejection. Discussion: Heterotopic heart transplantation is a surgical procedure that has a potential physiologic and immunologic advantage in select patients needing a heart transplant. Utilizing imaging guidance for navigating complex anatomy to perform a myocardial biopsy can have potential applications in providing safe and increasing yield in patchy diseases of the heart.