Anaesthetic management of a case of congenitally corrected transposition of great arteries for non cardiac surgery: A case report

Congenitally corrected transposition of the great arteries (CCTGA) is a rare form of congenital heart diseases, present with or without associated anomalies. It is a complex congenital heart disease with both atrioventricular and ventriculoarterial discordance. Such patients tend to develop systemic ventricular dysfuction with the stress of surgery. Patients with CCTGA are usually diagnosed at early stages of life due to associated anomalies, but they may even remain asymptomatic till later decades of their life. Literature search revealed very few reported cases of anaesthetic management of such high risk cases for non cardiac surgery. These patients have the tendency to develop cardiac dysrhythmias and left ventricular failure during intraoperative and postoperative period. We report anaesthetic management of a case of a 24 years old male with the congenitally corrected transposition of great arteries(CCTGA) who was operated for fracture left distal radius and ulna and right sided galeazzi fracture.

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A Case of Congenitally Corrected Transposition of Great Arteries: An Infrequent Happenstance

Case Reports in Medicine ◽

10.1155/2017/7565870 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Prakash Ajmera ◽

Vikas Medep

Keyword(s):

Ventricular Hypertrophy ◽

Heart Diseases ◽

Valvular Regurgitation ◽

Associated Anomalies ◽

Transposition Of Great Arteries ◽

The Past ◽

Congenitally Corrected Transposition ◽

Degree Heart Block ◽

Av Dissociation ◽

Corrected Transposition

Congenitally corrected transposition of the great arteries (CCTGA) is rare form of congenital heart diseases. It may be present with or without associated anomalies. Patients with CCTGA are usually diagnosed at early stages of life due to associated anomalies, but they may even remain asymptomatic till later decades of their life. We report a case of a 42-year-old man who presented at neurosurgery department with dizziness, seizures, and loss of consciousness, in whom isolated CCTGA was discovered incidentally. Further investigation depicted right ventricular hypertrophy, mild valvular regurgitation, mildly dilated pulmonary artery, low heart rate with AV dissociation, and third-degree heart block. These indicated for implantation of permanent pacemaker into the patient. The implantation of VVI mode pacemaker was uneventful and the patient is being followed up in the past eight months in favorable condition.

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A Case of Congenitally Corrected Transposition of Great Arteries (CCTGA)

Community Based Medical Journal ◽

10.3329/cbmj.v4i1.53561 ◽

2015 ◽

Vol 4 (1) ◽

pp. 37-40

Author(s):

Tofayel Uddin Ahmed ◽

M Mafizur Rahman ◽

Parvez Rahman Khan ◽

Mohammad Rajibul Hasan

Keyword(s):

Congenital Heart ◽

Heart Diseases ◽

Heart Defects ◽

Complex Form ◽

Exertional Dyspnea ◽

Transposition Of Great Arteries ◽

Scientific Attention ◽

Congenitally Corrected Transposition ◽

Complete Av Block ◽

Corrected Transposition

Recent years, much scientific attention has been given to congenital heart diseases (CHD) and probable complications. Congenitally corrected transposition of the great arteries (CCTGA) is a rare, complex form of congenital heart defects. CCTGA is characterized by atrioventricular (AV) and ventriculoarterial (VA) discordance and hence by a physiologically normal direction of blood flow sometimes called "double discordance". The development of complete AV block and global ventricular dysfunction has been identified as the cause of cardiac death. This paper presents a case of CCTGA with rhythm disorders and exertional dyspnea. CBMJ 2015 January: Vol. 04 No. 01 P: 37-40

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Ventricular assist device in a patient with congenitally corrected transposition of the great arteries and situs inversus totalis

The International Journal of Artificial Organs ◽

10.1177/0391398818823768 ◽

2019 ◽

Vol 42 (6) ◽

pp. 321-322

Author(s):

Radi Wieloch ◽

Nihat Firat Sipahi ◽

Udo Boeken ◽

Alexander Albert ◽

Payam Akhyari ◽

...

Keyword(s):

Ventricular Assist Device ◽

Situs Inversus ◽

Congenital Heart ◽

Heart Diseases ◽

Situs Inversus Totalis ◽

Clinical Scenario ◽

Assist Device ◽

Ventricular Assist ◽

Congenitally Corrected Transposition ◽

Corrected Transposition

Congenitally corrected transposition of the great arteries and situs inversus totalis are rare congenital anomalies. While congenital heart diseases affect about 0.75%–0.9% of newborns, less than 1% of them have congenitally corrected transposition of the great arteries. Meanwhile, the incidence of situs inversus totalis is about 0.01%. This is a case report of a patient with congenitally corrected transposition of the great arteries and situs inversus totalis who was supported with a ventricular assist device, resulting in a challenging clinical scenario.

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In congenitally corrected transposition of great arteries following Fontan surgery, a left ventricle with suprasystemic systolic and high end-diastolic pressures paradoxically preserves right ventricular and tricuspid valve function

Cardiology in the Young ◽

10.1017/s1047951119002324 ◽

2019 ◽

Vol 29 (12) ◽

pp. 1522-1523

Author(s):

Santosh Wadile ◽

Ejaz A. Sheriff ◽

Kothandam Sivakumar

Keyword(s):

Left Ventricle ◽

Right Ventricular ◽

Ventricular Function ◽

Right Ventricular Function ◽

Left Ventricular ◽

Transposition Of Great Arteries ◽

Valve Function ◽

Fontan Surgery ◽

Congenitally Corrected Transposition ◽

Corrected Transposition

AbstractSystemic right ventricular function in congenitally corrected transposition depends on septal geometry. Suprasystemic left ventricular systolic pressures and high end-diastolic pressures after Fontan surgery paradoxically preserve right ventricular function.

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Subpulmonary Obstruction Due to Aneurysmal Ventricular Septum in a Patient with Congenitally Corrected Transposition of the Great Arteries and Dextrocardia

University Heart Journal ◽

10.3329/uhj.v10i1.24596 ◽

2015 ◽

Vol 10 (1) ◽

pp. 31-38

Author(s):

Naveen Sheikh ◽

Sajal Krishna Banerjee ◽

Md Zahid Hossain ◽

Md Tariqul Islam ◽

Tahmina Karim ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Left Ventricular ◽

Ventricular Septum ◽

Transposition Of Great Arteries ◽

The Past ◽

Left Ventricular Outflow ◽

Patch Closure ◽

Congenitally Corrected Transposition ◽

Corrected Transposition

Congenitally corrected Transposition of Great Arteries is usually associated with multiple cardiac defects. Morphologic left-ventricular outflow (pulmonary) tract obstruction due to aneurysm of the membranous ventricular septum in patients with corrected transposition and ventricular septal defect is rare, but was reported in the past. This is even more uncommon in patients with dextrocardia, prompting us to document this case. Absence of the conus with resultant proximity of the aneurysm to the subpulmonary region and higher pressures in the left-sided morphologic right ventricle lead to obstruction of outflow tract in corrected transposition. Echocardiogram with Doppler interrogation and cardiac catheterization with selective cineangiography are the diagnostic tests of choice. Surgical resection of the aneurysm with patch closure of ventricular septal defect, avoiding injury to the conduction system, is recommended.University Heart Journal Vol. 10, No. 1, January 2014; 31-38

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The possibilities of computed tomography using heart-axis-oriented multiplanar reformations in diagnostics of the great arteries transposition

Pediatrician (St Petersburg) ◽

10.17816/ped9428-35 ◽

2018 ◽

Vol 9 (4) ◽

pp. 28-35

Author(s):

Gulnaz K. Sadykova ◽

Dmitry O. Ivanov ◽

Georgiy O. Bagaturia ◽

Victor V. Ipatov ◽

Vlarimir V. Ryazanov

Keyword(s):

Computed Tomography ◽

Data Analysis ◽

Heart Diseases ◽

Transposition Of Great Arteries ◽

Computed Tomographic ◽

Heart Chamber ◽

Multiplanar Reformations ◽

Congenitally Corrected Transposition ◽

Corrected Transposition

This article contents the results of computed tomography with intravenous bolus contrast media administration data analysis in children with transposition and congenitally corrected transposition of the great arteries with the consequental performing of the multiplanar heart-axis-oriented reformations. Among 148 examined children transposition of great arteries was detected in 13 patients (9 boys and 4 girls aged 1-144 day of life); congenitally corrected transposition was found in 4 cases of children aged from 6 months to 15 years and 6 months (2 boys and 2 girls). In this article comprehensive anatomical criteria of each heart chamber morphology are presented and reformations where these criteria can be seen are shown. Also in the article is given comparative characterization of heart and great arteries structures in transposition and congenitally corrected transposition in every certain heart-axis-oriented reformation. By the results of consequently performed heart-axis-oriented reformations data analysis the peculiar anatomical signs of transposition and congenitally corrected transposition are determined. The results of data analysis show that from the list of offered reformations the peculiar anatomical signs of both kinds of transposition are significantly determined in long-axis of right ventricle inflow tract reformation, left heart chambers reformation, supply ventricle division reformation, short-axis reformation at the level of great arteries. Computed tomographic angiocardiography heart-axis-oriented multiplanar reformations permit full and correct assessment of heart and main vessels, which is important for planning of surgical treatment in congenital heart diseases.

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Left Ventricular Systolic Impairment after Pediatric Cardiac Surgery Assessed by STE Analysis

Healthcare ◽

10.3390/healthcare9101338 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1338

Author(s):

Massimiliano Cantinotti ◽

Pietro Marchese ◽

Marco Scalese ◽

Paola Medino ◽

Vivek Jani ◽

...

Keyword(s):

Cardiac Surgery ◽

Speckle Tracking ◽

Congenital Heart ◽

Speckle Tracking Echocardiography ◽

Heart Diseases ◽

Left Ventricular ◽

Pediatric Cardiac Surgery ◽

Healthy Children ◽

Lv Ejection Fraction

Background: Speckle-tracking echocardiography (STE) has gained increasing value in the evaluation of congenital heart diseases (CHD); however, its use in pediatric cardiac surgery is limited. Aim: To evaluate left ventricular (LV) systolic impairment after biventricular pediatric cardiac surgery by STE strain (ε) analysis. Methods: We prospectively enrolled 117 children undergoing cardiac surgery for CHD. Echocardiography was performed at four different times: pre-operatively, 12–36 h (Time 1), 3–5 days (Time 2), and 6–8 days (Time 3). Images were obtained in the 4-2-and 3 apical chamber’s views to derive LV global and regional (basal/mid/apical) ε values. Results: At different postoperative times, we performed 320 examinations in 117 children (mean age: 2.4 ± 3.9, range: 0–16 years); 117 age-matched healthy children served as controls. All global, basal, and mid LVε values decreased after surgery; the lowest values being at Time 1 (p < 0.0001), which increased thereafter. At discharge, all global, basal, and mid LVε values remained lower than in pre-operative and healthy children (p < 0.05). Instead, apical segments (lowest at baseline) increased after surgery (p < 0.0001) but remained lower compared to controls. LV ejection fraction (LVEF) decreased at Time 1 (p = 0.0004) but promptly recovered to Time 2 and normalized at Time 3. Conclusions: STE ε analysis revealed a significant LV systolic impairment after surgery with amelioration thereafter but incomplete normalization at discharge. Base-apex differences emerged with apical segments that, contrary to all the other regions, showed relative hypercontractility after surgery. The slower recovery of LVε values compared to LVEF suggests that STE ε analysis may be more accurate for the follow-up of mild LV post-surgical impairment.

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Veleszületett szívhibák sebészi kezelése 60 éves kor felett

Orvosi Hetilap ◽

10.1556/650.2016.30415 ◽

2016 ◽

Vol 157 (21) ◽

pp. 820-824

Author(s):

István Hartyánszky ◽

Sándor Varga ◽

László Csepregi ◽

Barna Babik ◽

Judit Simon ◽

...

Keyword(s):

Heart Disease ◽

Valve Replacement ◽

Congenital Heart ◽

Heart Diseases ◽

Heart Defects ◽

Multiorgan Failure ◽

Ductus Arteriosus ◽

Right Ventricular Outflow Tract ◽

Left Ventricular ◽

Transposition Of Great Arteries

Introduction: The population with congenital heart disease is increasing and ageing. Aim: The aim of the authors was to examine the outcome of surgical management of congenital heart diseases beyond the age of 60 years. Method: Between 2013 and 2015, 77 adults were operated (36 younger, and 41 older than forty years, including 12 patients aged over 60 years. The numbers of procedures were as follows (in brackets the number of operations in the three age groups): Ross surgery 5 (3, 2, 0); aortic valve replacement 19 (12, 1, 6); subaortic membrane resection 1 (0, 0, 1); Bentall/ascending aortic plasty 8 (4, 3, 1); myectomy with or without mitral valve replacement in left ventricular outflow obstruction 5 (0, 3, 2); aortic coarctation 1 (1, 0, 0); ligation of ductus arteriosus 2 (1, 1, 0); reconstruction of right ventricular outflow tract with biological valve 4 (0, 3, 1); homograft 5 (5, 0, 0); BioValsalva graft 1 (0, 1, 0); primary reconstruction of complete atrioventricular septum defect 3 (1, 2, 0); valve replacement 2 (1, 1, 0); ventricular septum defect 10 (4, 6, 0); atrial septum defect closure 5 (2, 3, 0); total cavopulmonal anastomosis 1 (1, 0, 0); valve replacement in congenital transposition of great arteries 1 (0, 1, 0), Ebstein operation with valve plasty 2 (0, 1, 1); valve replacement 2 (1, 0, 1). Results: There was no operative mortality, while early mortality occurred in one patient with total cavopulmonal anastomosis due to multiorgan failure. Conclusions: Congenital heart defects can be operated beyond the age of 60 years with good results in a tertiary heart centre having great experience in the management of congenital and acquired heart disease. Orv. Hetil., 2016, 157(21), 820–824.

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Discordance is the Key

Indian Journal of Cardiovascular Disease in Women WINCARS ◽

10.1055/s-0038-1656460 ◽

2017 ◽

Vol 02 (01) ◽

pp. 052-055

Author(s):

K. Prasad ◽

A. Kumar

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Heart Diseases ◽

Mechanical Complication ◽

Rare Form ◽

Detailed Evaluation ◽

Artery Disease ◽

Congenitally Corrected Transposition ◽

Corrected Transposition

AbstractCongenitally corrected transposition of the great arteries (CCTGA) is a rare form of congenital heart disease characterised by atrioventricular as well as ventriculoarterial discordance. It is usually associated with a variety of severe intracardiac defects. Few patients with this abnormality survive past 50 years. A 54 Yr old male patient referred to our hospital for the management of post MI VSD. At the presentation Patient had mild central cyanosis, clubbing grade 2 and the vitals are stable. Cardiac examination revealed a 2/6 long ESM in a left parasternal area with pulsations in left 2nd and 3rd ICS. There is a lot of discrepancy in both clinical examination and workup. After detailed evaluation patient is diagnosed as having cyanotic congenital heart disease – L TGA + VSD with PS. Survival up to this age is very rare with this combination of associated defects in LTG. The patient is misdiagnosed as coronary artery disease with mechanical complication in another hospital. Unless there is suspicion and having knowledge about the asymptomatic presentation of congenital heart diseases up to this age group, patients will be misdiagnosed and treatment will be delayed.

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Anaesthesia for noncardiac surgery in children with congenital heart disease

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1102107s ◽

2011 ◽

Vol 139 (1-2) ◽

pp. 107-115

Author(s):

Dusica Simic ◽

Milan Djukic ◽

Ivana Budic ◽

Irina Milojevic ◽

Veljko Strajina

Keyword(s):

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Congenital Heart ◽

Heart Diseases ◽

Preoperative Assessment ◽

Individual Case ◽

Anaesthetic Management ◽

Team Approach ◽

Safe Delivery

Children with Congenital Heart Disease (CHD) presenting for non-cardiac surgery have various physiological and functional abnormalities and thus pose great challenges to the anaesthesiologist. The principles of anaesthesia are to minimize pathophysiological changes which may upset the complex interaction between systemic and pulmonary vascular resistance. Knowledge of the specific cardiac anatomy, familiarity with the modifications of the cardiorespiratory physiology, the awareness of the potential risks of complications for each individual case are mandatory for the choice of the anaesthesia strategy for each patient. During the preoperative assessment, the risk-benefit ratio should be estimated and preoperative plan established in order to optimize the preoperative status. An anaesthesiologist must also understand pharmacology of drugs being used and should tailor anaesthetic management to the type of surgery. An interdisciplinary team approach is the cornerstone for the safe delivery of anaesthesia to this paediatric patient population. The team should comprise an anesthesiologist, a paediatric cardiologist, a surgeon, a cardio-surgeon and a neonatologist. This review is meant to explain the classification of congenital heart diseases and to equip the anaesthesiologist with the necessary information about preoperative assessment, anaesthesiology management, monitoring tools important for the safe non-cardiac surgery procedures as well as therapeutic strategies during the postoperative period.

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