Introduction Congenitally corrected Transposition of the great Arteries(cc-TGA)is an uncommon congenital heart defect marked by double discordance of atrioventricular(AV)and ventriculoarterial connections.This dual di...Introduction Congenitally corrected Transposition of the great Arteries(cc-TGA)is an uncommon congenital heart defect marked by double discordance of atrioventricular(AV)and ventriculoarterial connections.This dual discordance naturally corrects the cardiopulmonary circulation.However,the embryological right ventricle(with its right bundle branch)becomes connected to the aorta,while the left ventricle(with its left bundle branch)is attached to the pulmonary artery.展开更多
BACKGROUND Corrected transposition of the great arteries(cTGA) is a cardiac malformation in which the ventricular and arterial-ventricular positions in the heart are doubly reversed.In general,this defect puts a load ...BACKGROUND Corrected transposition of the great arteries(cTGA) is a cardiac malformation in which the ventricular and arterial-ventricular positions in the heart are doubly reversed.In general,this defect puts a load on the systemic circulation and causes heart failure,resulting in a poor prognosis.This article reports a case of cTGA detected in a patient with post-caesarean pregnancy who had undergone elective caesarean section and was experiencing an episode of acute heart failure.CASE SUMMARY This was the case of a 36-year-old gravida 3 para 1 woman.No problems were noted in the puerperal course following the previous pregnancy.The current pregnancy was also uneventful.An elective caesarean section was performed and the patient was discharged from the hospital 7 d after the operation.On postoperative day 18,the patient became aware of breathing difficulty and presented at a nearby clinic,where she was referred to our institution after bilateral pleural effusions were detected.She was then diagnosed with acute heart failure after noting the presence of a prominent pedal oedema and SpO_(2) 91%(supine position and room air);the patient was promptly hospitalised for close examination and treatment.Although chest computed tomography revealed the presence of cTGA,no other cardiac malformations were observed.Owing to improvements in both the pedal oedema and pleural effusions,the patient was discharged on day 9.CONCLUSION Close examination should be performed on the premise of congenital cardiac malformation when heart failure symptoms are noted during perinatal control.展开更多
BACKGROUND Treatment of congenitally corrected transposition of great arteries(cc-TGA)with anatomic repair strategy has been considered superior due to restoration of the morphologic left ventricle in the systemic cir...BACKGROUND Treatment of congenitally corrected transposition of great arteries(cc-TGA)with anatomic repair strategy has been considered superior due to restoration of the morphologic left ventricle in the systemic circulation.However,data on long term outcomes are limited to single center reports and include small sample sizes.AIM To perform a systematic review and meta-analysis for observational studies reporting outcomes on anatomic repair for cc-TGA.METHODS MEDLINE and Scopus databases were queried using predefined criteria for reports published till December 31,2017.Studies reporting anatomic repair of minimum 5 cc-TGA patients with at least a 2 year follow up were included.Metaanalysis was performed using Comprehensive meta-analysis v3.0 software.RESULTS Eight hundred and ninety-five patients underwent anatomic repair with a pooled follow-up of 5457.2 patient-years(PY).Pooled estimate for operative mortality was 8.3%[95%confidence interval(CI):6.0%-11.4%].0.2%(CI:0.1%-0.4%)patients required mechanical circulatory support postoperatively and 1.7%(CI:1.1%-2.4%)developed post-operative atrioventricular block requiring a pacemaker.Patients surviving initial surgery had a transplant free survival of 92.5%(CI:89.5%-95.4%)per 100 PY and a low rate of need for pacemaker(0.3/100 PY;CI:0.1-0.4).84.7%patients(CI:79.6%-89.9%)were found to be in New York Heart Association(NYHA)functional class I or II after 100 PY follow up.Total re-intervention rate was 5.3 per 100 PY(CI:3.8-6.8).CONCLUSION Operative mortality with anatomic repair strategy for cc-TGA is high.Despite that,transplant free survival after anatomic repair for cc-TGA patients is highly favorable.Majority of patients maintain NYHA I/II functional class.However,monitoring for burden of re-interventions specific for operation type is very essential.展开更多
Subcutaneous implantable cardioverter-defi brillator(S-ICD)therapy has become a viable alternative to conventional transvenous ICD implantation.Patients with congenitally corrected transposition of the great arteries(...Subcutaneous implantable cardioverter-defi brillator(S-ICD)therapy has become a viable alternative to conventional transvenous ICD implantation.Patients with congenitally corrected transposition of the great arteries(ccTGA)have a high risk of sudden cardiac death due to malignant arrhythmia.The interaction between the S-ICD system and the transvenous pacemaker system is not fully understood.We report a case of S-ICD implantation in a patient with ccTGA and a DDD pacemaker.The patient was a 30-year-old man with a previously placed pacemaker with diagnoses of congenital heart disease,ccTGA(SLL),left atrioventricular valve insuffi ciency,and third-degree atrioventricular block.He presented with an out-of-hospital cardiac arrest,and an S-ICD was implanted to prevent sudden cardiac death.Defi brillation checks were performed successfully.We tested the compatibility of the DDD pacemaker with the S-ICD and found that there was no interference between them.In conclusion,an S-ICD system is a reasonable and safe option in patients with ccTGA.展开更多
<strong>Introduction:</strong><span style="white-space:normal;"><span style="font-family:;" "=""> Congenitally corrected transposition of the great arter...<strong>Introduction:</strong><span style="white-space:normal;"><span style="font-family:;" "=""> Congenitally corrected transposition of the great arteries (CCTGA) is a rare heart disease that encompasses an atrioventricular and ventriculoarterial discordance and accounts for less than 1 percent of congenital heart diseases. <b>Objective: </b></span></span><span style="white-space:normal;"><span style="font-family:;" "="">To p</span></span><span style="white-space:normal;"><span style="font-family:;" "="">resent </span></span><span style="white-space:normal;"><span style="font-family:;" "="">an </span></span><span style="white-space:normal;"><span style="font-family:;" "="">atypical case of a man with complex congenital heart disease and conduction anomalies. <b>Case Presentation:</b> This is a case of a 34-year-old patient who came to the hospital with 1 week of dyspnea on exertion and episodes of lipothymia. The patient was referred to our hospital after an electrocardiogram from his primary care with evidence of blocked atrial fibrillation. During the initial evaluation blocked atrial fibrillation was confirmed with a rescue ventricular rate of 38 bpm. A magnetic resonance confirmed the presence of the atrioventricular and ventriculoarterial discordance, the aorta had a left anterior position, perimembranous ventricular septal defect with a right to left shunt, biventricular systolic dysfunction, moderate tricuspid, and mitral regurgitation, interventricular septal intramyocardial and biatrial fibrosis, left</span> </span><span style="white-space:normal;"><span style="font-family:;" "="">atrial dilation, and dilation of the pulmonary artery. After pacemaker placement, the patient has an improvement in his clinical symptoms and quality of life. <b>Conclusions:</b> Cardiac arrhythmias are CCTGA’s leading cause of death, mostly ventricular tachycardia, and atrial fibrillation. Right bundle branch block is a previously unreported and potentially very rare presentation of this disease. This, added to the fact that our patient was diagnosed at an advanced age, but without symptoms of heart failure, makes</span></span><span style="white-space:normal;"><span style="font-family:;" "=""> </span></span><span style="white-space:normal;"><span style="font-family:;" "="">him</span></span><span style="white-space:normal;"><span style="font-family:;" "=""> </span></span><span style="white-space:normal;"><span style="font-family:;" "="">an atypical case of CCTGA, with new potential treatment options.</span></span>展开更多
Congenitally corrected transposition of the great arteries(CCTGA)is a rare congenital heart disease characterized by atrioventricular,ventriculoarterial,and conduction system discordance,commonly accompanied by atriov...Congenitally corrected transposition of the great arteries(CCTGA)is a rare congenital heart disease characterized by atrioventricular,ventriculoarterial,and conduction system discordance,commonly accompanied by atrioventricular block(AVB).Pacing in patients with CCTGA and AVB(both pediatric and adult)poses challenges in strategy selection,procedural complexity,and clinical decision-making due to limited evidence.Conventional morphological left ventricular pacing is widely adopted but may induce ventricular dyssynchrony,heart failure,and tricuspid valve dysfunction.While cardiac resynchronization therapy serves as an upgrade for pacing-induced cardiomyopathy and heart failure,its application may be limited by coronary sinus anatomical variations and uncertain clinical outcomes.His bundle pacing is rarely reported due to the variation of the His bundle and high pacing threshold.The superficial,wide,multi-branched left bundle branch favors left bundle branch pacing,though delayed systemic right ventricle(sRV)activation may cause ventricular dyssynchrony and impair sRV function.Right bundle branch pacing offers a novel alternative for pacing therapy.Conduction system pacing-optimized cardiac resynchronization therapy is preferred in those with evidence of intrinsic ventricular conduction dysfunction.This narrative review synthesizes current evidence on pacing strategies for CCTGA with AVB,integrating anatomical and pathophysiological insights to evaluate physiological pacing strategies,while highlighting critical knowledge gaps to guide future research.展开更多
Reported in this paper are 8 cases of corrected transposition of the great arteries associated with anomalies. All the patients underwent the repair of the ventricular septal defect and atrial septal defect, the repla...Reported in this paper are 8 cases of corrected transposition of the great arteries associated with anomalies. All the patients underwent the repair of the ventricular septal defect and atrial septal defect, the replacement of left-side tricuspid valve, the pulmonary valvotomy and the placement of extra-cardiac conduit to the pulmonary trunk respectively with no hospital death after operation.The paper also described the selection of the heart incision, the prevention of injury of the conduction system and indication of the placement of extra-cardiac conduit.展开更多
文摘Introduction Congenitally corrected Transposition of the great Arteries(cc-TGA)is an uncommon congenital heart defect marked by double discordance of atrioventricular(AV)and ventriculoarterial connections.This dual discordance naturally corrects the cardiopulmonary circulation.However,the embryological right ventricle(with its right bundle branch)becomes connected to the aorta,while the left ventricle(with its left bundle branch)is attached to the pulmonary artery.
文摘BACKGROUND Corrected transposition of the great arteries(cTGA) is a cardiac malformation in which the ventricular and arterial-ventricular positions in the heart are doubly reversed.In general,this defect puts a load on the systemic circulation and causes heart failure,resulting in a poor prognosis.This article reports a case of cTGA detected in a patient with post-caesarean pregnancy who had undergone elective caesarean section and was experiencing an episode of acute heart failure.CASE SUMMARY This was the case of a 36-year-old gravida 3 para 1 woman.No problems were noted in the puerperal course following the previous pregnancy.The current pregnancy was also uneventful.An elective caesarean section was performed and the patient was discharged from the hospital 7 d after the operation.On postoperative day 18,the patient became aware of breathing difficulty and presented at a nearby clinic,where she was referred to our institution after bilateral pleural effusions were detected.She was then diagnosed with acute heart failure after noting the presence of a prominent pedal oedema and SpO_(2) 91%(supine position and room air);the patient was promptly hospitalised for close examination and treatment.Although chest computed tomography revealed the presence of cTGA,no other cardiac malformations were observed.Owing to improvements in both the pedal oedema and pleural effusions,the patient was discharged on day 9.CONCLUSION Close examination should be performed on the premise of congenital cardiac malformation when heart failure symptoms are noted during perinatal control.
文摘BACKGROUND Treatment of congenitally corrected transposition of great arteries(cc-TGA)with anatomic repair strategy has been considered superior due to restoration of the morphologic left ventricle in the systemic circulation.However,data on long term outcomes are limited to single center reports and include small sample sizes.AIM To perform a systematic review and meta-analysis for observational studies reporting outcomes on anatomic repair for cc-TGA.METHODS MEDLINE and Scopus databases were queried using predefined criteria for reports published till December 31,2017.Studies reporting anatomic repair of minimum 5 cc-TGA patients with at least a 2 year follow up were included.Metaanalysis was performed using Comprehensive meta-analysis v3.0 software.RESULTS Eight hundred and ninety-five patients underwent anatomic repair with a pooled follow-up of 5457.2 patient-years(PY).Pooled estimate for operative mortality was 8.3%[95%confidence interval(CI):6.0%-11.4%].0.2%(CI:0.1%-0.4%)patients required mechanical circulatory support postoperatively and 1.7%(CI:1.1%-2.4%)developed post-operative atrioventricular block requiring a pacemaker.Patients surviving initial surgery had a transplant free survival of 92.5%(CI:89.5%-95.4%)per 100 PY and a low rate of need for pacemaker(0.3/100 PY;CI:0.1-0.4).84.7%patients(CI:79.6%-89.9%)were found to be in New York Heart Association(NYHA)functional class I or II after 100 PY follow up.Total re-intervention rate was 5.3 per 100 PY(CI:3.8-6.8).CONCLUSION Operative mortality with anatomic repair strategy for cc-TGA is high.Despite that,transplant free survival after anatomic repair for cc-TGA patients is highly favorable.Majority of patients maintain NYHA I/II functional class.However,monitoring for burden of re-interventions specific for operation type is very essential.
文摘Subcutaneous implantable cardioverter-defi brillator(S-ICD)therapy has become a viable alternative to conventional transvenous ICD implantation.Patients with congenitally corrected transposition of the great arteries(ccTGA)have a high risk of sudden cardiac death due to malignant arrhythmia.The interaction between the S-ICD system and the transvenous pacemaker system is not fully understood.We report a case of S-ICD implantation in a patient with ccTGA and a DDD pacemaker.The patient was a 30-year-old man with a previously placed pacemaker with diagnoses of congenital heart disease,ccTGA(SLL),left atrioventricular valve insuffi ciency,and third-degree atrioventricular block.He presented with an out-of-hospital cardiac arrest,and an S-ICD was implanted to prevent sudden cardiac death.Defi brillation checks were performed successfully.We tested the compatibility of the DDD pacemaker with the S-ICD and found that there was no interference between them.In conclusion,an S-ICD system is a reasonable and safe option in patients with ccTGA.
文摘<strong>Introduction:</strong><span style="white-space:normal;"><span style="font-family:;" "=""> Congenitally corrected transposition of the great arteries (CCTGA) is a rare heart disease that encompasses an atrioventricular and ventriculoarterial discordance and accounts for less than 1 percent of congenital heart diseases. <b>Objective: </b></span></span><span style="white-space:normal;"><span style="font-family:;" "="">To p</span></span><span style="white-space:normal;"><span style="font-family:;" "="">resent </span></span><span style="white-space:normal;"><span style="font-family:;" "="">an </span></span><span style="white-space:normal;"><span style="font-family:;" "="">atypical case of a man with complex congenital heart disease and conduction anomalies. <b>Case Presentation:</b> This is a case of a 34-year-old patient who came to the hospital with 1 week of dyspnea on exertion and episodes of lipothymia. The patient was referred to our hospital after an electrocardiogram from his primary care with evidence of blocked atrial fibrillation. During the initial evaluation blocked atrial fibrillation was confirmed with a rescue ventricular rate of 38 bpm. A magnetic resonance confirmed the presence of the atrioventricular and ventriculoarterial discordance, the aorta had a left anterior position, perimembranous ventricular septal defect with a right to left shunt, biventricular systolic dysfunction, moderate tricuspid, and mitral regurgitation, interventricular septal intramyocardial and biatrial fibrosis, left</span> </span><span style="white-space:normal;"><span style="font-family:;" "="">atrial dilation, and dilation of the pulmonary artery. After pacemaker placement, the patient has an improvement in his clinical symptoms and quality of life. <b>Conclusions:</b> Cardiac arrhythmias are CCTGA’s leading cause of death, mostly ventricular tachycardia, and atrial fibrillation. Right bundle branch block is a previously unreported and potentially very rare presentation of this disease. This, added to the fact that our patient was diagnosed at an advanced age, but without symptoms of heart failure, makes</span></span><span style="white-space:normal;"><span style="font-family:;" "=""> </span></span><span style="white-space:normal;"><span style="font-family:;" "="">him</span></span><span style="white-space:normal;"><span style="font-family:;" "=""> </span></span><span style="white-space:normal;"><span style="font-family:;" "="">an atypical case of CCTGA, with new potential treatment options.</span></span>
文摘Congenitally corrected transposition of the great arteries(CCTGA)is a rare congenital heart disease characterized by atrioventricular,ventriculoarterial,and conduction system discordance,commonly accompanied by atrioventricular block(AVB).Pacing in patients with CCTGA and AVB(both pediatric and adult)poses challenges in strategy selection,procedural complexity,and clinical decision-making due to limited evidence.Conventional morphological left ventricular pacing is widely adopted but may induce ventricular dyssynchrony,heart failure,and tricuspid valve dysfunction.While cardiac resynchronization therapy serves as an upgrade for pacing-induced cardiomyopathy and heart failure,its application may be limited by coronary sinus anatomical variations and uncertain clinical outcomes.His bundle pacing is rarely reported due to the variation of the His bundle and high pacing threshold.The superficial,wide,multi-branched left bundle branch favors left bundle branch pacing,though delayed systemic right ventricle(sRV)activation may cause ventricular dyssynchrony and impair sRV function.Right bundle branch pacing offers a novel alternative for pacing therapy.Conduction system pacing-optimized cardiac resynchronization therapy is preferred in those with evidence of intrinsic ventricular conduction dysfunction.This narrative review synthesizes current evidence on pacing strategies for CCTGA with AVB,integrating anatomical and pathophysiological insights to evaluate physiological pacing strategies,while highlighting critical knowledge gaps to guide future research.
文摘Reported in this paper are 8 cases of corrected transposition of the great arteries associated with anomalies. All the patients underwent the repair of the ventricular septal defect and atrial septal defect, the replacement of left-side tricuspid valve, the pulmonary valvotomy and the placement of extra-cardiac conduit to the pulmonary trunk respectively with no hospital death after operation.The paper also described the selection of the heart incision, the prevention of injury of the conduction system and indication of the placement of extra-cardiac conduit.
