title: HeartWare Ventricular Assist Device Placement in a Patient With Corrected Dextro-Transposition of Great Arteries: A Case Report and Its Clinical Challenges.
abstract: Given the improved survival in patients with corrected dextro-transposition of great arteries (D-TGA), it has evolved into an adult congenital heart defect. It is important to understand the management and complications observed in this population that eventually progresses to systemic ventricular failure requiring cardiac transplantation. Our case focuses on the rapid right ventricle (RV) deterioration of a patient with corrected D-TGA following a surgical procedure requiring systemic support. With such patients awaiting heart transplantation, there are limited assist devices available for RV support and no right ventricular assist device is approved for destination therapy yet. Current indications for implantation of the HeartWare ventricular assist device (HVAD) are limited by the Food and Drug Administration (FDA) to the left ventricle support as a bridge to transplantation. However, its use in the United States for right-sided support has rarely been described for adult congenital defects. In this case, a HeartWare assist device was used to provide systemic support as a bridge to cardiac transplant. The size and implantation design of the HVAD makes it a promising option for patients with this challenging patient population and RV failure as a late complication.
authors.affiliation: Hahnemann University Hospital/Drexel University College of Medicine, Philadelphia, PA, USA sehgal_sankalp@yahoo.com.
authors.forename: Sankalp
authors.initials: S
authors.lastname: Sehgal
authors.affiliation: Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Sujatha
authors.initials: S
authors.lastname: Ramachandran
authors.affiliation: Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Leff
mesh_terms: D000328:Adult; D004867:Equipment Design; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000503:physiopathology; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D014188:Transposition of Great Vessels / Q000503:physiopathology / Q000601:surgery*; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology / Q000601:surgery*
keywords: Mustard procedure; adult congenital heart disease; dextro-transposition of great arteries (D-TGA); transesophageal echocardiography (TEE); ventricular assist device (VAD)