Sugimoto Ai, Takigiku Kiyohiro, Shiraishi Shuichi, Takahashi Masashi, Tsuchida Masanori
Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Niigata City, 951-8510, Japan.
Department of Pediatric Cardiology, Nagano Children's Hospital, Azumino City, Japan.
Surg Case Rep. 2020 May 13;6(1):101. doi: 10.1186/s40792-020-00863-4.
In a Fontan candidate, univentricular pacing may cause delay in interventricular conduction, which induces asynchronous contraction. Cardiac resynchronization therapy is expected to be an effective mode of therapy in such a case.
A 7-month-old girl, diagnosed with dextrocardia, congenitally corrected transposition of the great artery [situs solitus, L-loop, and L-transposition], ventricular septal defect, infundibular and pulmonary valvular stenosis, and straddling of the tricuspid valve, was considered as a candidate for the Fontan procedure. She had undergone Blalock-Taussig shunt, and epicardial univentricular pacemaker implantation for persistent complete atrioventricular block. She underwent a bidirectional cavopulmonary shunt concomitant with ventricular lead translocation from the morphological left ventricle to the morphological right ventricle. After discharge, ventricular dyssynchrony was noted and cardiac failure persisted. She was converted to cardiac resynchronization therapy (CRT) at 13 months of age. Two-dimensional speckle tracking imaging was used by cardiologists to determine the most suitable pacing site. CRT rapidly corrected the heart failure; thus, she underwent the Fontan procedure after 1.5 years. Five years have passed since the cardiac resynchronization therapy; her interventricular synchrony is maintained well and the level of brain natriuretic peptide remains within normal range.
We describe the successful conversion from single ventricular pacing to CRT, in a case of congenitally corrected transposition of the great artery indicated for the Fontan procedure. The long-term prognosis of cardiac resynchronization therapy is undetermined in the pediatric population; therefore, further follow-up is required.
在一名Fontan手术候选患者中，单心室起搏可能导致心室间传导延迟，进而引发不同步收缩。心脏再同步治疗有望成为此类病例的有效治疗方式。
一名7个月大的女孩，被诊断为右位心、先天性矫正型大动脉转位（心房正位、L袢、L转位）、室间隔缺损、漏斗部及肺动脉瓣狭窄以及三尖瓣骑跨，被视为Fontan手术的候选者。她曾接受Blalock-Taussig分流术，并因持续性完全房室传导阻滞植入了心外膜单心室起搏器。她接受了双向腔肺分流术，同时将心室导线从形态学左心室移位至形态学右心室。出院后，发现存在心室不同步，且心力衰竭持续存在。她在13个月大时转为心脏再同步治疗（CRT）。心脏病专家使用二维斑点追踪成像来确定最合适的起搏部位。CRT迅速纠正了心力衰竭；因此，她在1.5年后接受了Fontan手术。自心脏再同步治疗以来已过去5年；她的心室同步性保持良好，脑钠肽水平仍在正常范围内。
我们描述了一例因先天性矫正型大动脉转位而适合Fontan手术的患者，成功从单心室起搏转换为CRT。儿童人群中心脏再同步治疗的长期预后尚不确定；因此，需要进一步随访。
