Systemic right ventricle complications in levo-transposition of the great arteries: A case report and review of literature  

作　　者：Mohamed Ramzi Almajed Abdulla Almajed Naoshin Khan Mark S Obri Karthikeyan Ananthasubramaniam 

机构地区：[1]Department of Internal Medicine,Henry Ford Hospital,Detroit,MI 48202,United States [2]College of Medicine and Medical Sciences,Arabian Gulf University,Manama 00000,Bahrain [3]Heart and Vascular Institute,Henry Ford West Bloomfield Hospital,West Bloomfield,MI 48322,United States

出　　处：《World Journal of Cardiology》2023年第10期542-552,共11页世界心脏病学杂志（英文版）（电子版）

摘　　要：BACKGROUND Congenitally corrected levo-transposition of the great arteries(L-TGA)is a congenital heart disease in which the ventricles and great arteries are transposed from their typical anatomy.In L-TGA,the double discordance,atrioventricular and ventriculoarterial,create an acyanotic milieu which allows patients to survive their early decades,however,progressive systemic right ventricle(sRV)dys-function creates complications later in life.sRV dysfunction and remodeling predisposes patients to intracardiac thrombus(ICT)formation.CASE SUMMARY A 40-year-old male with L-TGA presented with symptoms of acute decom-pensated heart failure.In childhood,he had surgical repair of a ventricular septal defect.In adulthood,he developed sRV dysfunction,systemic tricuspid valve(sTV)regurgitation,and left-bundle branch block for which he underwent cardiac resynchronization therapy.Transthoracic echocardiogram showed a sRV ejection fraction of 40%,severe sTV regurgitation,and a newly identified sRV ICT.ICT was confirmed by ultrasound-enhancing agents and transesophageal echocardio-graphy.Our patient was optimized with guideline-directed medical therapy and diuresis.Anticoagulation was achieved with a vitamin K antagonist(VKA)and he was later referred for evaluation by advanced heart failure and heart transplant services.CONCLUSION Anticoagulation with VKA is the mainstay of treatment in the absence of conclusive data supporting direct oral anticoagulant use in ICT in patients with congenital heart disease.This case illustrates the natural history of L-TGA and highlights the importance of surveillance and monitoring with dedicated cardiac imaging to identify complications.

关 键 词：Levo-transposition of the great arteries Systemic right ventricle Congenital heart disease Intracardiac thrombus ANTICOAGULATION Direct oral anticoagulant Case report 

分 类 号：R714.252[医药卫生—妇产科学]