title: [Experience with heterotopic heart transplantation in patients with elevated pulmonary vascular resistance: late follow-up].
abstract: BACKGROUND
  Along the past few years the number of papers on heterotopic cardiac transplant has been very scarce in the medical literature, including at the international level; this is particularly true in reference to the long term follow-up of these patients and the reason which led to the presentation of our report.
  
  
  OBJECTIVE
  To report the initial clinical experience and late evolution of 4 patients undergoing heterotopic heart transplantation, indications for this procedure and its major complications.
  
  
  METHODS
  The surgeries were performed between 1992 and 2001, and all had as indication for heterotopic transplantation the PVR, which ranged from 4.8 WU to 6.5 WU, with a transpulmonary gradient above 15 mmHg. In the 3rd patient, a direct anastomosis between the pulmonary arteries was performed without the use of a prostetic tube, and a mitral valvuloplasty and a LV aneurysmectomy were performed in the native heart. The immediate immunosuppressive regimens were double, with cyclosporine and azathioprine in the first 3 patients, and cyclosporine and mycophenolate mofetil in the 4th patient.
  
  
  RESULTS
  One immediate death occurred from graft failure, one death occurred after 2 (1/2) years, from endocarditis in an intraventricular thrombus in the native heart, and a third death occurred 6 years after transplantation, from post-operative complications of the aortic valve surgery in the native heart. The remaining patient is well, 15 years after the transplantation. This patient is in functional class II (NYHA), 6 years after a surgical occlusion of the native heart aortic valve.
  
  
  CONCLUSIONS
  Heterotopic heart transplantation results are inferior to those of orthotopic heart transplantation because they present higher RVP. The intraventricular thrombi, in the native heart, which require prolonged anticoagulation, and aortic valve complications, also in the native heart, may require surgical treatment. However, a patient's 15-year survival has demonstrated a long-term effectiveness of this option for selected patients.
authors.affiliation: Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil. jhavila@cardiol.br
authors.forename: Jose Henrique Andrade
authors.initials: JH
authors.lastname: Vila
authors.forename: José Pedro da
authors.initials: JP
authors.lastname: Silva
authors.forename: Luciana da
authors.initials: Ld
authors.lastname: Fonseca
authors.forename: José Francisco
authors.initials: JF
authors.lastname: Baumgratz
authors.forename: Américo
authors.initials: A
authors.lastname: Tangari
authors.forename: Weverton Ferreira
authors.initials: WF
authors.lastname: Leite
authors.forename: Claudia Jesus
authors.initials: CJ
authors.lastname: Guilhen
authors.forename: Egas
authors.initials: E
authors.lastname: Armelin
mesh_terms: D000328:Adult; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000473:pathology; D008875:Middle Aged; D016042:Transplantation, Heterotopic / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D016896:Treatment Outcome