the right atrium of the donor heart was extended further into the right atrium to ensure a wide connection between both atria. The anastomosis was started by suturing the inferior angle of the incision in the donor atrium to the midpoint of the posterior edge of the incision in the native atrium (Fig. IC and D). A large hemoclip was placed around the upper limit of the anastomosis on the donor SVC to act as a reference point during endomyocardial biopsy. The donor aorta was then anastomosed to the ascending aorta end-to-side, using continuous 4-0 prolene suture (Fig. IE). Care was taken to ensure adequate length of the donor aorta and a wide anastomotic opening. Using the preclotted Dacron tube graft, the distal
anastomosis between the graft and the native pulmonary artery trunk was made with continuous 5-0 prolene suture. The proximal endto-end anastomosis between the graft and the pulmonary artery was then similarly completed (Fig. IF). Rewarming was usually started after the aortic anastomosis was completed. Thorough inspection of all suture lines was done. Air was completely removed from both hearts, and the aortic cross-clamp was removed. Occasionally, both hearts had to be defibrillated with electrical shock.
POSTOPERATIVE COURSE All three patients did well postoperatively. The immunosuppressive regimen was the
1E Anastomosis of the donor-heart aorta to the recipient ascending aorta. 226
Vol. 12, No. 3, September, 1985