Partial heart transplant in the setting of truncus arteriosus after several corrections and definitive contraindication for anticoagulation due to immune thrombocytopenia

We report the case of a 12-year-old boy with a history of type I truncus arteriosus repaired in early infancy. He underwent initial correction at 2 months of age, conduit replacement between the right ventricle and pulmonary artery at 4 years, and truncal valve replacement with a bioprosthesis at 8 years. He was referred with severe aortic regurgitation, severe aortic stenosis, free regurgitation of the right ventricle-pulmonary artery conduit with moderate stenosis and preserved biventricular function. Long-term anticoagulation was formally contraindicated due to immune thrombocytopenic purpura treated with eltrombopag since 2020. A fourth redo sternotomy for mechanical aortic valve replacement was considered to be exceedingly high risk in the context of his complex anatomy, prior operative history, and haematological risk profile. In light of these factors, we elected to perform a partial heart transplantation, as recently described by Turek et al., to replace the dysfunctional aortic and pulmonary root and valve while preserving the patient's heart muscle, therefore minimizing the need for immunosuppression. This case illustrates the potential role of partial heart transplantation as an alternative to conventional valve replacement in complex congenital heart disease when anticoagulation is contraindicated.