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A 64-year-old man presented with progressive shortness of breath and exercise intolerance due to end-stage ischemic cardiomyopathy. Since he remained severely symptomatic despite maximal medical therapy, he underwent a heterotopic cardiac transplantation. Because of the presence of severe pulmonary hypertension, the recipient's native heart (N) was left in place and the allograft was implanted in the right chest. The native heart maintains right circulation in spite of chronic pulmonary hypertension, while the heterotopic donor heart (D) functions as a biologic left ventricular assist device. The post-transplantation electrocardiogram shows two QRS complexes with different axes (Panel A). The allograft can be seen clearly in the right chest on both the radiograph (Panel B) and the computed tomographic scan (Panel C) of the chest. An automatic implantable cardiac defibrillator and cardiac medications are used to treat the recipient's native heart, as are immunosuppressive medications for the allograft.
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