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A 41-year-old man with acute-on-chronic decompensated heart failure presented for evaluation for heart transplantation. He had non-ischaemic cardiomyopathy and had undergone a heterotopic heart transplantation (HHT) 24 years earlier. His severe pulmonary hypertension necessitated a heterotopic transplant, with the native heart maintaining the right circulation while the donor heart worked as a biologic left ventricular assist device. His ECG showed two QRS …
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