Introduction
A 43-year-old male with a history of dextro-transposition of the great arteries (D-TGA) status post Mustard palliation at 6 months of age presented with acute exacerbations of systolic heart failure (NYHA IV) over three months with the latest admission involving a non-ST elevation myocardial infarction. Cardiac catheterization demonstrated low cardiac output (1.4 L/min) and elevated pulmonary capillary wedge pressure (24 mmHg). While admitted, his clinical condition deteriorated to INTERMACS level 2 with progressive decline of hemodynamics despite inotropic support. He was indicated for a surgically implanted mechanical circulatory support, specifically a HeartMate III (HM3), for destination therapy in the systemic right ventricle (RV). The anatomy of a hypertrophic and dilated right ventricle (RV) presents challenges to inflow cannula implantation. Here, we describe a technique of papillary muscle repositioning to facilitate LVAD insertion.