Peritoneal dialysis for refractory heart failure from a congenitally corrected transposition of the great arteries who has not undergone definitive surgery: A case report

@#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.

Double artery transposition: Coronary pattern and great arteries / Doble transposición arterial: Patrón coronario y grandes arterias

Extensive anatomic variability of the coronary arteries in hearts with transposition of great arteries has been described. Usual coronary pattern is defined as right coronary artery arising from posterior facing sinus and left coronary artery from anterior facing sinus. Results of prior case series have suggested that certain coronary patterns are associated with adverse outcomes in surgery (arterial switch operation). We present the case of a neonate with prenatal diagnosis of transposition of great arteries. Postnatal transthoracic echocardiography showed great arteries in a side-by-side relationship (fig. 1). Coronary pattern was described as inverted or with double coronary looping, which represents less than 3% of the anatomical variants. The entire left coronary artery system arose from the posterior-facing sinus, whereas the right coronary artery arose from the aorta anteriorly. Left coronary artery pursued a retropulmonary course, dividing posteriorly into the circumflex and anterior descending arteries (fig. 2). The patient underwent arterial switch operation uneventfully.

Transposición congénitamente corregida de grandes arterias en adultos asintomáticos diagnosticada circunstancialmente por ecocardiografía: casos clínicos / Asymptomatic congenitally corrected transposition of the great arteries: report of two cases

Congenitally corrected transposition of the great arteries is a rare congenital anomaly that can remain asymptomatic until adulthood, especially when there are no other associated congenital anomalies. We report two patients in their sixth decade of life with corrected transposition of the great arteries incidentally diagnosed by transthoracic echocardiography in a preventive medical check-up. The complementary use of cardiac computed tomography confirmed the diagnosis.

Experiencia inicial en la cirugía Jatene, en pacientes con transposición clásica de grandes arterias, en el Hospital Nacional de Niños Benjamín Bloom, de junio de 2015 a junio de 2016, serie de casos / Initial experience in Jatene surgery, in patients with classic transposition of the great arteries, at the Benjamín Bloom National Children's Hospital, from June 2015 to June 2016, case series

La transposición clásica de las grandes arterias (TGA) o llamada también discordancia ventrículo arterial, es una anomalía cardiaca congénita en la que la aorta emerge del ventrículo derecho (VD) y la arteria pulmonar del ventrículo izquierdo (VI). Es el segundo defecto cardiaco congénito más común con una prevalencia a nivel mundial de 0.24/1000 nacidos vivos. Antes de la era quirúrgica, la Transposición de grandes arterias, (TGA), representaba la quinta parte de las muertes cardiacas en la niñez. En junio de 2015, fue realizada en El Salvador la primera cirugía Jatene; en el Hospital Nacional de Niños Benjamín Bloom (HNNBB), siendo este el principal centro de referencia nacional e institución pública de tercer nivel de atención que cuenta con un programa cardiovascular, tanto clínico como quirúrgico, desde hace 20 años y que brinda atención cardiaca a la niñez con defectos congénitos y adquiridos de El Salvador; por lo que a través del presente estudio damos a conocer la experiencia inicial obtenida