Left ventricular retraining and anatomic correction in teenage patient with congenitally corrected transposition of the great arteries.
Left ventricular (LV) retraining followed by anatomical repair would be a superior alternative in patients with congenitally corrected transposition (ccTGA) having a deconditioned morphologically left ventricle (MLV); however, LV retraining in older children is a challenging task. A retraining process of the MLV in a teenage patient with ccTGA is reported here. Cardiac catheterization at 7 years of age revealed low pressure of the MLV (33/4 mm Hg) and a LV to right ventricular pressure ratio (LVp/RVp ratio) of 0.32. The first pulmonary artery banding (PAB) was performed at 10 years of age. Although the LVp/RVp ratio reached 0.68, there was no evidence of adequate LV hypertrophy. The second PAB was performed 2 years after the initial PAB, resulting in an increase in the LVp/RVp ratio to 0.93 and an adequate LV hypertrophy. The double switch procedure was successfully performed at 13 years of age. Although the ejection fraction of the MLV mildly decreased, the patient has been doing well during a follow-up period of 4 years. The MLV in the teenage patient with ccTGA was successfully trained using a retraining strategy and has sustained systemic circulation after anatomical repair.
Honjo
Osami
O
Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine and Dentistry. osami.honjo@sickkids.ca
Kawada
Masaaki
M
Akagi
Teiji
T
Kotani
Yasuhiro
Y
Ishino
Kozo
K
Sano
Shunji
S
D000293:Adolescent; D001775:Blood Circulation / Q000502:physiology; D006348:Cardiac Surgical Procedures / Q000379:methods*; D006346:Heart Septum / Q000503:physiopathology / Q000601:surgery; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000503:physiopathology / Q000601:surgery; D008297:Male; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation; D013318:Stroke Volume / Q000502:physiology; D014188:Transposition of Great Vessels / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000601:surgery*