Manalili Sheryll Anne R, Mejia Agnes D, Estacio Ronaldo H
Division of Nephrology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila.
Department of Adult Cardiology, Philippine Heart Center.
Acta Med Philipp. 2023 Apr 28;57(4):57-62. doi: 10.47895/amp.vi0.4495. eCollection 2023.
Heart failure (HF) is a major cause of significant morbidity, mortality, and hospitalization worldwide including the Philippines. Congenitally corrected transposition of the great arteries (C-TGA) occurs when the right atrium enters the morphological left ventricle which gives rise to the pulmonary artery and the left atrium communicates with the right ventricle which gives rise to the aorta. Heart failure can occur in C-TGA especially if associated with other heart defects. Ideal management is anatomic correction via surgery to prevent or address heart failure. Peritoneal dialysis has been used as a therapeutic intervention for patients with refractory heart failure and kidney injury with or without kidney failure due to its gentler fluid removal compared to conventional ultrafiltration resulting in less myocardial stunning and neurohormonal activation. We present the case of a patient with heart failure who started on peritoneal dialysis (PD) as an adjunct therapy for fluid management after failing to satisfactorily achieve volume control with diuretics. The patient is a 56-year-old man with C-TGA admitted for decompensated heart failure. He was initially treated with intravenous diuretics on the first admission but was readmitted after 3 months for decompensation this time with borderline low blood pressure making diuresis difficult. The patient was given loop diuretics, tolvaptan, and angiotensin receptor neprilysin inhibitor (ARNI) but still with decreasing trends in urine output and inadequate symptom control. PD was initiated before discharge with subsequent improvement in heart failure symptoms. The patient was on regular follow-up for PD maintenance and titration of heart failure medication. In this case report, we have shown how PD can be an effective adjunct to guideline-directed medical therapy in patients with severely symptomatic heart failure who have an unstable hemodynamic status and for which volume management cannot be satisfactorily achieved with diuretics.
心力衰竭（HF）是包括菲律宾在内的全球范围内导致严重发病、死亡和住院的主要原因。先天性矫正型大动脉转位（C-TGA）是指右心房进入形态学上的左心室，该左心室发出肺动脉，而左心房与发出主动脉的右心室相连。心力衰竭可发生在C-TGA患者中，尤其是合并其他心脏缺陷时。理想的治疗方法是通过手术进行解剖矫正，以预防或治疗心力衰竭。腹膜透析已被用作治疗难治性心力衰竭和合并或不合并肾衰竭的肾损伤患者的一种治疗手段，因为与传统超滤相比，其液体清除更为温和，导致较少的心肌顿抑和神经激素激活。我们报告一例心力衰竭患者，在使用利尿剂未能满意控制容量后，开始采用腹膜透析（PD）作为液体管理的辅助治疗。该患者为一名56岁男性，患有C-TGA，因失代偿性心力衰竭入院。首次入院时最初接受静脉利尿剂治疗，但3个月后因失代偿再次入院，此时血压临界低值，使利尿困难。给予患者襻利尿剂、托伐普坦和血管紧张素受体脑啡肽酶抑制剂（ARNI），但尿量仍呈下降趋势，症状控制不佳。出院前开始进行PD治疗，随后心力衰竭症状有所改善。患者接受定期随访以维持PD治疗并调整心力衰竭药物剂量。在本病例报告中，我们展示了对于有严重症状且血流动力学不稳定、使用利尿剂无法满意实现容量管理的心力衰竭患者，PD如何能成为指南指导药物治疗的有效辅助手段。
