**3. Adult congenital heart disease recipients**

Recipients of Adult congenital heart disease needing heart transplantation for advanced heart failure have generally undergone multiple open-heart procedures in the past. Therefore, they might need additional donor tissue to reconstruct the recipient anatomy.

In those recipients with an anomalous left superior vena cava (LSVC), the implanting surgeon will need extra length of the SVC and also need to harvest the innominate vein to allow for restoration of continuity of the LSVC in the recipient [4]. On the other hand, in the donors with an LSVC one must be extra conscious of the donor heart vasculature. There have been noted cases where the coronary sinus drains into the LSVC instead of the RA [5]. Ligating the LSVC without ascertaining drainage to the RA could prove to be disastrous for the recipient because after implantation and circulation restoration, the heart has no drainage avenue and hence may become edematous and lead to primary graft dysfunction. Any additional systemic/pulmonary venous drainage anomalies are also important to note on both the recipient and donor.

For certain circumstances, such as a recipient with complex congenital heart disease who may require reconstruction of the pulmonary arteries, additional tissue may need to be procured either in continuity with the donor heart or separately, such as the descending thoracic aorta or innominate vein. If possible, the PA bifurcation along with the RPA and LPA should be procured if the lungs are not being placed [6].

If possible for these subset of patients it is important to procure a long length of the donor aorta till the arch, the PA with the bifurcation and extra lengths of RPA and LPA, donor carotid artery, descending thoracic aorta, donor pericardium, etc. to aid reconstruction and repair in the recipient.
