Introduction
A 43-year-old male with a history of dextro-transposition of the great
arteries (D-TGA) status post Mustard palliation at 6 months of age
presented with acute exacerbations of systolic heart failure (NYHA IV)
over three months with the latest admission involving a non-ST elevation
myocardial infarction. Cardiac catheterization demonstrated low cardiac
output (1.4 L/min) and elevated pulmonary capillary wedge pressure (24
mmHg). While admitted, his clinical condition deteriorated to INTERMACS
level 2 with progressive decline of hemodynamics despite inotropic
support. He was indicated for a surgically implanted mechanical
circulatory support, specifically a HeartMate III (HM3), for destination
therapy in the systemic right ventricle (RV). The anatomy of a
hypertrophic and dilated right ventricle (RV) presents challenges to
inflow cannula implantation. Here, we describe a technique of papillary
muscle repositioning to facilitate LVAD insertion.