Novel heart diseases requiring transplantation.

Cardiac transplantation represents an extraordinary opportunity to study in vivo the pathology of native disease in the terminal phase. The experience cumulated at the University of Padua in 418 orthotopic cardiac transplant procedures allowed to come across previously unrecognized disease: idiopathic left ventricular aneurysm, non-compacted (spongy) myocardium, restrictive cardiomyopathy. A discrepancy between pre- and post-transplant diagnosis was found in 8% of cases. Endomyocardial biopsy and coronary arteriography should be carried out in each patient with apparently dilated cardiomyopathy before proceeding to heart removal, since alternative therapeutic procedures may be available.