Sehgal Sankalp, Ramachandran Sujatha, Leff Jonathan D
Hahnemann University Hospital/Drexel University College of Medicine, Philadelphia, PA, USA
Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
Semin Cardiothorac Vasc Anesth. 2015 Sep;19(3):243-7. doi: 10.1177/1089253214566886. Epub 2015 Jan 18.
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.
鉴于大动脉转位（D-TGA）矫正术后患者生存率的提高，该病已发展成为一种成人先天性心脏缺陷。了解这一最终进展为需要心脏移植的系统性心室衰竭人群中所观察到的管理方法和并发症很重要。我们的病例聚焦于一名接受需要全身支持的手术后，矫正型D-TGA患者右心室（RV）的迅速恶化。对于此类等待心脏移植的患者，可用于右心室支持的辅助装置有限，且尚无右心室辅助装置被批准用于终末期治疗。目前，心脏辅助装置（HVAD）植入的指征受到美国食品药品监督管理局（FDA）的限制，仅限于作为移植桥梁的左心室支持。然而，在美国，其用于右侧支持治疗成人先天性缺陷的情况鲜有报道。在此病例中，使用了心脏辅助装置（HVAD）来提供全身支持，作为心脏移植的桥梁。HVAD的尺寸和植入设计使其成为这一具有挑战性的患者群体和作为晚期并发症的右心室衰竭患者的一个有前景的选择。
