Neopulmonary venous confluence for heart transplantation with giant left atrium

Heart transplantation in a recipient with giant left atrium is rare. To correct the mismatch between recipient and donor at the level of the left atrium, plication of the left atrium has been proposed. We report a case in which plication was not feasible due to significant calcification of the left atrial wall and tight pericardial adhesions resulting from 2 previous sternotomies. Creating a pulmonary venous confluence allows orthotopic heart transplantation with any size of left atrium and conformation of pulmonary veins in cases of significant calcification and/or redo sternotomy.