Congestive heart failure is highly prevalent in the elderly population and left ventricular assist device has been increasingly used in this population. LVAD therapy is more costly than medical treatment but it increases the survival and quality of life of the elderly patients with low disease acuity. Therefore careful selection of candidates and implementation of LVAD therapy earlier in the course of the disease is crucial to improve outcomes. With the technical advances and improvement in clinical management, the financial burden of LVAD therapy in the elderly will become less, making this therapy more economically feasible.
Background and aim of the study: Congenitally corrected transposition of the great arteries (cc-TGA) is a rare type of congenital heart disease and heart-lung transplant (HLTx) is the potential solution if the patient developed severe biventricular failure.. Aim of the study is to present a challenging case of cc-TGA with dextrocardia managed by HLTx. Methods: A 53-year-old male patient was presented to our institution with biventricular failure. The echocardiogram revealed cc-TGA, dextrocardia with situs solitus, atrioventricular discordance and ventriculoatrial discordance, severe systemic and sub-pulmonary atrioventricular valves regurgitation, and severe pulmonary hypertension. He underwent heart-lung transplant. Results: The patient was discharged on postoperative day 25 on room air with normal left ventricular ejection fraction. Conclusion: This case highlights the complexity of preoperative and intraoperative management of cc-TGA, and demonstrates the challenges which the surgeons and anesthesiologists may face during the procedure of HLTx.
The use of extracorporeal circulation (ECC) for intraoperative cardiopulmonary support during lung transplantation has been increasing in the recent years. Our group previously described a novel hybrid extracorporeal membrane oxygenation (ECMO) circuit for use in lung transplantation. Our novel technique for intraoperative management of this circuit during lung transplantation is described.