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We present a case of heterotopic heart transplantation in a 47 year old man who had post-ischaemic dilated cardiomyopathy. The patient presented with an anterior myocardial infarction (MI) in 1989 and an inferior MI seven years later. Coronary radiography showed a double vessel disease and ventriculography an ejection fraction of 0.25. In March 1997 the patient underwent double coronary bypass by means of internal mammary artery (LIMA) to left anterior descending coronary artery and saphenous vein to right coronary artery. A few months following surgery the patient started to complain of debilitating dyspnoea and in December 1999 he was considered for heart transplantation. Right heart catheterisation showed systolic pulmonary pressure of 94 mm Hg and 7.1 Wood units, and therefore he had to be considered for heterotopic heart transplantation. Finally in December 2003 he underwent heterotopic heart transplantation and during the operation the two coronary grafts implanted before were found to be functioning.
The figure represents a three dimensional reconstruction—multidetector spiral computed tomography (Sensation 16 Siemens)—of the two hearts, anteroposterior view; it is possible to identify the LIMA and the saphenous vein.