Department of Electrocardiology, Institute of Cardiology, Jagiellonian University Collegium Medicum, John Paul II Hospital in Krakow, Krakow, Poland.
Cardiol J. 2010;17(5):503-8.
Cardiac resynchronization therapy (CRT) is an acknowledged treatment for advanced heart failure in acquired dilated cardiomyopathy, resistant to pharmacotherapy. Although there are no therapeutic standards regarding heart failure originating from congenital heart defects with systemic right ventricle, a number of CRT implantations by transvenous approach in congenitally corrected transposition of the great arteries (CCTGA) have been reported since 2001, even though none of them expressly referred to a case concomitant with dextrocardia and situs inversus anomaly. We present a 57 year-old patient with dextrocardia and CCTGA, who underwent surgical closure of interatrial and interventricular septal defects at the age of 19, and in whom a VVI pacemaker was subsequently implanted at age 36. A three-lead CRT system was implanted by transvenous approach. Imaging techniques, including multi-slice computed tomography, targeted to pacing system and unusual anatomical relationships were applied. Within a 20-month follow-up, a significant improvement of functional NYHA class, systemic right ventricle ejection fraction and exercise capability were observed. Entirely transvenous CRT system implantation is feasible in patients with dextrocardia and CCTGA, and has substantial potential for long-term benefits.
心脏再同步治疗（CRT）是一种公认的治疗获得性扩张型心肌病伴药物治疗抵抗的晚期心力衰竭的方法。尽管对于起源于先天性心脏病伴全身右心室的心力衰竭尚无治疗标准，但自 2001 年以来，已经有许多通过经静脉途径植入 CRT 的报道，尽管其中没有一个明确涉及同时伴有右位心和内脏逆位的病例。我们报告了一位 57 岁的患者，他患有右位心和校正型大动脉转位（CCTGA），19 岁时接受了房间隔和室间隔缺损的手术闭合，36 岁时随后植入了 VVI 起搏器。通过经静脉途径植入了三导联 CRT 系统。应用了包括多层计算机断层扫描在内的影像学技术，以靶向起搏系统和异常的解剖关系。在 20 个月的随访中，观察到患者的 NYHA 心功能分级、全身右心室射血分数和运动能力有显著改善。对于右位心和 CCTGA 患者，完全经静脉 CRT 系统植入是可行的，具有长期获益的巨大潜力。
