Primary PCI in a patient with congenitally corrected transposition of the great arteries

Abstract

Available online xxxxCongenitally corrected transposition of the great arteries (CCTGA) is a rare disease in which there is both ventriculoarterial and atrioventricular discordance. The systemic ventricle is of right morphology and patients are at high risk of developing systemic ventricular dysfunction. We report on a 41 year old male patient with primary PCI and congenitally corrected transposition of the great arteries. IntroductionCongenitally corrected transposition of the great arteries (CCTGA), first described by Karl von Rokitansky in 1875. CCTGA is a rare disease in which there is both ventriculoarterial and atrioventricular discordance. 1 The atrioventricular discordance implies that the morphological left atrium into the morphological right ventricle (RV), and the morphological right atrium drains into the morphological left ventricle (LV). Thus, the RV supports the systemic circulation, and the LV supplies the pulmonary circulation. The systemic ventricle is of right morphology and patients are at high risk of developing systemic ventricular dysfunction. 2 The clinical course is complicated by associated intracardiac defects such as ventricular septal defect, left atrioventricular valve regurgitation, subvalvar and valvar pulmonary stenosis, and atrioventricular conduction disturbances. Their life expectancy is limited by the onset of systemic (morphologically right) ventricular failure in their 40s or 50s. 3 We report here the interesting case of primary PCI (Percutaneous Coronary Intervention) with congenitally corrected transposition of the great arteries. Case reportA 41 year old male presented to the emergency department complaining of chest pain with no history of previous episodes in the 5 March 2011. His chest pain began at the rest and lasted several hours. The pain was substernal, with radiation to his back and left arm. He had several risk factors including smoking and dyslipidemia.On admission, he was diaphoretic and restless. His pulse was regular at 85 beats/min and his blood pressure was 110/70 mm-Hg. Physical examination showed no remarkable findings. His initial electrocardiogram (ECG) demonstrated sinus rhythm, 2 mm ST elevation and peaked T wave in leads V1-V3 and negative T wave in leads D1,aVL,V4-V6, incomplete LBBB (Fig. 1). We administered 100 IU/kg unfractionated heparin i.v., 300 mg aspirin per os (chewed), 600 mg clopidogrel per os. It was decided to perform emergency coronary angiography with primary PCI.The left coronary angiogram was performed. Left main was normal. LAD had got 40% stenosis after first diagonal (D1). D1 was small and had got proximal 60% stenoses. Coronary angiography showed two Cx arteries arising from the left main and right coronary arteries. Coronary angiography revealed that the left Cx (LCx) originating from the left main coronary artery was normal. There was another Cx (RCx) arising from the proximal part of the right coronary artery (RCA) with a significant stenosis in the mid segment. The right coronary angiogram was performed and it was shown tha...

Nature Decides Survival

“…As survival beyond the fifth decade is uncommon, significant atherosclerotic coronary artery disease is rarely found and reported. On review of published articles, there are very few reported cases of MI in CCTGA, and there is only 1 reported case of primary angioplasty performed for MI in a 41-year-old patient ( 4 ). The 76-year-old patient in the present case, to the best of the authors’ knowledge, is the oldest in the world who has undergone primary angioplasty for acute ST-segment elevation MI.…”

Case report: new onset heart failure in congenitally corrected transposition of the great arteries, dextrocardia, and situs inversus in an octogenarian

“…As a result, not much data exist regarding the role common adult acquired secondary causes of systemic ventricular failure, such as hypertensive heart disease, diabetes mellitus, or coronary artery disease, may play in systemic RV failure in ccTGA. Only a handful of published cases described acute coronary syndrome (ACS) in ccTGA patients who were diagnosed with varying degrees of coronary artery disease [12][13][14]. The degree to which coronary artery disease may contribute to systemic RV dysfunction and long-term outcomes has yet to be established in the aging population with ccTGA.…”