Tadokoro Naoki, Fukushima Satsuki, Hoashi Takaya, Yajima Shin, Taguchi Takura, Shimizu Hideyuki, Fujita Tomoyuki
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-7 Kishibeshinmachi, Suita, Osaka 564-8565, Japan.
Department of Cardiovascular Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
Eur Heart J Case Rep. 2020 Nov 18;4(6):1-9. doi: 10.1093/ehjcr/ytaa359. eCollection 2020 Dec.
A systemic right ventricle (RV) after atrial switch in transposition of the great arteries (TGA) or congenitally corrected TGA (ccTGA) often results in advanced heart failure in adulthood.
Four patients with INTERMACS Class III underwent durable ventricular assist device (VAD) implantation for a systemic RV. Two patients were diagnosed with ccTGA and underwent tricuspid valve replacement, and two were diagnosed with TGA in childhood and underwent Mustard repair. The two patients with ccTGA received an EVAHEART (Sun Medical, Nagano, Japan) and HeartMate 3 (Abbott Laboratories, Abbott Park, IL, USA) at the age of 56 years and 34 years, respectively. Of the patients with TGA, one received a Heartmate II at age 40 years, and one received a HeartMate 3 at age 40 years. All patients were weaned from cardiopulmonary bypass without subpulmonic VAD support and transferred to the intensive care unit with optimum VAD support. No in-hospital deaths, cerebrovascular accidents, or other major complications occurred. The post-VAD right heart catheter study showed a remarkable reduction in pulmonary capillary wedge pressure in all patients.
The indications for and surgical technique of durable VAD implantation for a systemic RV after atrial switch of TGA or ccTGA have not been fully established. A durable VAD, including the HeartMate 3, was successfully implanted in four such patients in this study. Pre-operative three-dimensional computed tomography images and intraoperative transoesophageal echocardiography guidance helped to determine the positions of the inflow and pump.
大动脉转位（TGA）或先天性矫正型大动脉转位（ccTGA）心房调转术后的系统性右心室（RV）常导致成年期晚期心力衰竭。
4例国际机械循环辅助装置（INTERMACS）分级为III级的患者因系统性右心室接受了持久性心室辅助装置（VAD）植入。2例患者被诊断为ccTGA并接受了三尖瓣置换术，2例在儿童期被诊断为TGA并接受了Mustard手术。2例ccTGA患者分别在56岁和34岁时接受了EVAHEART（日本长野太阳医疗公司）和HeartMate 3（美国伊利诺伊州阿伯特帕克市雅培实验室）。TGA患者中，1例在40岁时接受了Heartmate II，1例在40岁时接受了HeartMate 3。所有患者均在无肺下VAD支持的情况下脱离体外循环，并在最佳VAD支持下转入重症监护病房。未发生院内死亡、脑血管意外或其他重大并发症。VAD植入术后右心导管检查显示所有患者肺毛细血管楔压显著降低。
TGA或ccTGA心房调转术后系统性右心室植入持久性VAD的适应证和手术技术尚未完全确立。本研究中，包括HeartMate 3在内的持久性VAD成功植入了4例此类患者。术前三维计算机断层扫描图像和术中经食管超声心动图引导有助于确定流入道和泵的位置。
