FFR-Guided PCI in a 17-Year-Old Patient after Arterial Switch Operation for D-Transposition of the Great Arteries

Asymptomatic coronary artery obstruction represents a significant diagnostic challenge in patients with Dextro-Transposition of the Great Arteries andhistory of Arterial Switch Operation. We report the case of a 17-year-old boy withanomalous origin of left circumflex artery from the right coronary artery, whounderwent neonatal arterial switch operation and developed silent myocardialischemia under stress on myocardial scintigraphy. Despite coronary angiogramand intravascular ultrasound showed only intermediate stenosis of the right coronary artery ostium, the physiological analysis, through the employment of pressurewire, demonstrated a severe reduction of coronary fractional flow reserve afterpharmacologically induced hyperemia. Thus, the patient was treated with implantation of drug eluting stent. Invasive fractional flow reserve of coronary stenosismay represent a useful tool to guide revascularization strategy in this population.     

Percutaneous Fetal Atrial Balloon Septoplasty for Simple Transposition of the Great Arteries With an Intact Atrial Septum

We report the first ultrasonographically guided percutaneous balloon atrial septoplasty (BAS), to our knowledge, in a fetus with transposition of the great arteries and an intact ventricular and atrial septum (37 + 2 weeks). After vaginal delivery at 38 weeks, the infant had an elective septostomy (day 1) and an arterial switch procedure (day 7), with an uneventful postoperative course. For centres with experience in fetal cardiac interventions, fetal BAS is a superior management option compared with the alternatives for this high-risk physiology.     

Late-Onset Pulmonary Hypertension After the Atrial Switch Procedure for Transposition of the Great Arteries

Background: Pulmonary hypertension (PH) is one of the complications that can occur after the atrial switch procedure for transposition of the great arteries (TGA). This study aimed to assess the characteristics and prognosis of late-onset PH after the atrial switch procedure using catheterization data. Methods and Results: We retrospectively identified 40 patients with TGA after the atrial switch procedure that underwent catheterization between April 2007 and March 2020. Eligible patients were divided into two groups based on PH presence (PH group, n = 13 [33%]; non-PH group, n = 27 [67%]). Adverse events were defined as cardiac death and heart failure. Of the included patients, 63% were male, the mean (± standard deviation [SD]) age was 34.3 ± 8.8 years, and 43% had Mustard operations. During the follow-up period (mean ± SD, 4.3 ± 3.5 years), adverse events were significantly more common in the PH group than in the non-PH group (hazard ratio 4.5, 95% confidence interval 0.99-23.0, logrank p = 0.032). There were five patients who underwent catheterization twice during the follow-up period. Two of the five patients who had post capillary PH had improved PH and New York Heart Association (NYHA) class due to appropriate early treatment initiation for heart failure, which included diuretics, angiotensinconverting-enzyme inhibitor/angiotensin II receptor blocker, and β-blockers. Conclusions: PH is very prevalent in adults with TGA who underwent the atrial switch procedure and is associated with an adverse prognosis. Early appropriate therapy might improve PH and NYHA class after the atrial switch procedure.     

Near‐fatal Outcome of Late Cardiac Perforation by a Pacemaker Lead in a Young Woman with Transposition of the Great Arteries

We report a case of ventricular perforation by an active‐fixation permanent pacemaker lead in a young woman with congenital heart defect and pacemaker because of atrioventricular block. The rarity of the case is based not only upon the late perforation (as opposed to the more common acute perforations) but also on the near‐fatal outcome. The patient experienced sharp chest pain and 1 week later passed out with cardiac arrest.     

New Procedure of Treatment for Combined Systemic Venous and Pulmonary Venous Obstruction Following the Mustard Operation for Transposition of the Great Arteries

Three patients aged 4.6, and 9 years were discovered at cardiac catheterization to have combined pulmonary venous and systemic venous obstruction following the Mustard operation for transposition of the great arteries. Relief of systemic venous baffle obstruction may unmask pulmonary venous obstruction. Full evaluation of the pulmonary venous confluence is recommended in any patient with systemic baffle obstruction.     

Percutaneous Extraction of Transvenous Defibrillator Leads Using the VascoExtor Pacing Lead Removal System

In the implantable cardioverter defibrillator era the necessity for lead removal is not negligible. A specially designed extraction lead system for percutaneous removal of such leads is lacking, in contrast to the existing pacing lead extraction systems. We report the successful percutaneous extraction of four implantable cardioverter defibrillator leads in three patients because of lead malfunction using a novel pacemaker lead extraction system, the VascoExtor (VascoMed) system. Three leads were successfully removed in two patients using traction with special locking stylets from the superior approach. One lead was removed using the system's additional extraction tools through the femoral approach. There were no complications. This preliminary experience shows that the VascoExtor (VascoMed) pacemaker lead extraction system can also be used in implantable cardioverter defibrillator lead extraction safely and effectively. In addition to the locking stylets, adjunct percutaneous extraction tools may be needed in some cases.     

Transesophageal Echocardiographic Identification of a Bicuspid Pulmonary Valve Associated with Congenitally Corrected Transposition of the Great Arteries

We are reporting, for the first time, the echocardiographic identification of a bicuspid pulmonary valve associated with congenitally corrected transposition of the great arteries.     

Flail Tricuspid Valve in an Adult Patient with Congenitally Corrected Transposition of the Great Arteries

We describe a case of a 50-year-old woman with congenitally corrected transposition of the great vessels, in whom severe left-sided tricuspid (systemic atrioventricular) valve insufficiency was the only associated anomaly. The tricuspid valve was dysplastic and abnormally oriented toward the interventricular septum, without the downward displacement of Ebstein's anomaly. The mechanism of atrioventricular regurgitation was unusual in that it consisted of the rupture of chordae tendineae of both the anterior and septal leaflets. The left-sided tricuspid valve was replaced with a St. Jude prosthesis and the postoperative course was uneventful.     

Does Left Atrial Volume and Pulmonary Venous Anatomy Predict the Outcome of Catheter Ablation of Atrial Fibrillation?

Introduction: Preprocedural factors may be helpful in selecting patients with atrial fibrillation (AF) for treatment with catheter ablation and in making an assumption regarding their prognosis. The aims of this study were to investigate whether left atrial (LA) volume and pulmonary venous (PV) anatomy, evaluated by computed tomography (CT) prior to ablation, will predict AF recurrence following catheter ablation.
Methods and Results: We included 146 patients (mean age 57 ± 11 years, 83% male) with symptomatic AF (55% paroxysmal, 18% persistent, 27% long-standing persistent). All patients underwent CT scanning prior to catheter ablation to evaluate LA volume and PV anatomy. Circumferential PV isolation was performed guided by Cartomerge electroanatomical mapping. The outcome was defined as complete success, improvement, or failure.
After a mean follow-up of 19 ±7 months, complete success was achieved in 59 patients (40%), and 38 patients (26%) demonstrated improvement. LA volume was found to be an independent predictor of AF recurrence with an adjusted OR of 1.14 for every 10-mL increase in volume (95% CI 1.00–1.29, P = 0.047). PV variations were equally distributed among the different outcomes of the ablation procedure, and therefore univariate analysis did not identify PV anatomy as a predictor of outcome.
Conclusion: LA volume is an independent predictor of AF recurrence after catheter ablation. Additionally, PV anatomy did not have any effect on the outcome. These findings suggest that an assessment of LA volume may be incorporated into the preprocedural evaluation of patients being considered for AF ablation.     

同种带瓣外管道在校正型大动脉转位合并室间隔缺损及肺动脉瓣狭窄矫正手术中的应用

目的 :评价同种带瓣外管道在校正型大动脉转位合并室间隔缺损 (室缺 )及肺动脉瓣狭窄矫正术中应用的临床效果。方法 :1995年 1月～ 2 0 0 1年 6月 ,13例校正型大动脉转位合并室缺及肺动脉瓣狭窄或肺动脉闭锁患者接受应用同种带瓣外管道矫治手术 ,9例应用同种带瓣肺动脉 ,4例应用同种带瓣主动脉 ,同时修补室缺。患者平均年龄 10 0± 5 1( 5 0～ 2 7 0 )岁 ,平均体重 2 8 5± 14 6( 15 0～ 5 2 0 )kg。结果 :无手术死亡 ,6例手术后并发症 ,其中 2例术后安装永久起搏器。术后机械辅助呼吸时间平均 2 9 7± 2 4 4( 9～ 90 )小时。术后住院时间平均 14 6± 6 7( 7～ 2 6)天。无晚期死亡及并发症发生。结论 :同种带瓣外管道手术治疗校正型大动脉转位合并室缺及肺动脉狭窄可取得满意的手术疗效     

Selected Slow Pathway Ablation in a Patient with Corrected Transposition of the Great Arteries and Atrioventricular Nodal Reentrant Tachycardia

AVNRT in Corrected TGA. We report the first known case of AV nodal reentrant tachycardia (AVNRT) associated with a corrected transposition of the great arteries to be treated successfully by ablation of the slow pathway. Triple AV nodal pathways were observed in the anterograde direction and two types of AVNRT were induced. Input of the fast pathway to the AV node was located at the anterior portion of the left-sided A V annulus, while the input of the intermediate and slow pathways was located at the anteroseptal portion of the right-sided AV annulus. Radiofrequency energy ablation at the right anteroseptal site eliminated the intermediate and slow pathways.     

Congenitally Corrected Transposition of the Great Arteries and Concomitant Coronary Artery and Valvular Disease in the Adult Patient

Congenitally corrected transposition of the great arteries (ccTGA) accounts for less that 1% of cardiac anomalies, and is defined as ventriculoarterial and atrioventricular (AV) discordance. The double discordant connection allows for survival with the right ventricle performing as the systemic ventricle, and the left ventricle as the pulmonary ventricle. We report a case of ccTGA in a 35-year-old male with situs inversus totalis status post repair of a ventricular septal defect (VSD) with a residual VSD, severe systemic AV valve regurgitation, and coronary artery disease who presented with chest pain. He subsequently underwent tricuspid valve replacement and VSD repair, followed by percutaneous coronary revascularization. This case highlights many important issues of adults with congenital cardiac disease, as well as the specific surgical management of anomalies associated with ccTGA. We review the literature and discuss the management of these complicated patients.     

A New Technique for the Transvenous Implantation of the Over-the-Wire Left Ventricular Pacing Lead in a Patient with Heart Failure

Implantation of left ventricular leads (LV) for biventricular pacing remains a technological challenge and failure of the procedure is not uncommon. We described a 58 year-old patient with heart failure and intraventricular conduction delay where difficulty is encountered when cannulating the coronary sinus by the guiding catheter. By placing a guiding catheter in the inferior portion of the right atrium, a coronary guidewire, preloaded with an over-the-wire lead system, was used to reach the lateral cardiac vein. This may help to reduce the implant failure rate and avoid other more invasive means of LV lead implantation.     

Dynamic Pulmonary Artery Obstruction Causing Right Ventricular Failure after Cardiac Transplantation in a Patient with Mustard–Senning Corrected d‐Transposition of the Great Arteries

Patients with congenital d‐transposition of the great arteries (d‐TGA) undergoing palliative atrial baffle surgery in infancy often develop systemic ventricular failure in adulthood. If they undergo cardiac transplantation, they are prone to morphologic right ventricular (RV) failure secondary to severe pulmonary hypertension as a result of systemic ventricular failure. We report a case of a patient with d‐TGA and biventricular ventricular failure requiring heart transplantation (HT) that developed RV failure postoperatively because of dynamic pulmonary artery (PA) obstruction at the anastomotic site of PA. Obstruction at the site of PA anastomosis due to torsion or redundancy of the donor or recipient PA is a rare but treatable cause of postoperative RV failure. In this case, rapid identification of the etiology of RV failure and implementation of corrective therapies before the development of end‐organ dysfunction, resulted in complete RV recovery and normal allograft function. This case represents the first known report of dynamic PA anastomoticobstruction resulting in RV failure after HT that was corrected with pulmonary arterioplasty, and RV assist device resulting in complete recovery.     

A Combination of Two Simultaneous Tachycardias in the Right Atrium Close to the Atrio-Ventricular Node and Within the Coronary Sinus in a Post-Operative Cor Triatriatum Patient

A 71-year-old male was referred to another hospital for dizziness. A bradycardia -tachycardia syndrome and Cor triatriatum were detected, and an operation to resect the membrane in the left atrium and implant a pacemaker epicardially was performed. However, no suitable site could be found on either atria and therefore, a single chamber ventricular pacemaker was implanted. In the electrophysiological study performed in our hospital, we could not detect any atrial potentials in either atria, excluding the region close to the His bundle (HB) and within coronary sinus (CS), in spite of extensive catheter mapping. A regular atrial rhythm with a cycle length of 820 ms, which was synchronous with the rate of the QRS complex on the surface ECG, was recorded only at the HB. Meanwhile, the CS catheter recording exhibited regular focal activity with a cycle length of 150 ms, and this focal activity did not conduct to the atrium close to the HB. Furthermore, this activity was dissociated from the ventricular activity recorded from the CS catheter. During an isoproterenol infusion, an atrial tachycardia with a cycle length of 380 ms was recorded only at the HB, and the twelve-lead ECG exhibited a regular tachycardia with the same cycle length as this tachycardia. Meanwhile, the focal activity within the CS persisted without any change in the cycle length. These findings suggested that there was dissociation between the right atrium (RA) and CS. Furthermore, partial atrial standstill was observed in both atria, excluding the RA close to the atrio-ventricular (AV) node and area within the CS. These rare electrophysiological features were considered to play an important role in the genesis of a simultaneous combination of the two tachycardias at their respective sites.