Download DDD Pacemaker Implantation in A Patient with Congenitally

DDD Pacemaker Implantation in A Patient with Congenitally
Corrected Transposition of the Great Arteries: A Case Report
The Heart Center of Chonnam National University Hospital, Gwangju, Korea
Doo Sun Sim, MD, Nam Sik Yoon, MD, Hyun Ju Yoon, MD, Jae Youn Moon, MD,
Kye Hun Kim, MD, Young Joon Hong, MD, Hyung Wook Park, MD, Ju Han Kim, MD,
Youngkeun Ahn, MD, Myung Ho Jeong, MD, Jeong Gwan Cho, MD, Jong Chun Park,
MD, and Jung Chaee Kang, MD
A 56 year-old man presented with dizziness of three days’ duration. His blood pressure
was 140/90 mmHg and his ECG showed complete atrioventricular block (CAVB) with
ventricular escape rhythm (35 bpm). Mild cardiomegaly was noted in the chest X-ray.
Temporary pacemaker insertion was attempted via a transfemoral approach, during
which it was found that he had no inferior vena cava (IVC) draining into the right
atrium (RA). Venogram showed venous drainage into the superior vena cava (SVC)
from a dilated azygos vein (Fig A). Accordingly, the electrode was positioned in the
right-sided ventricle via the azygos vein and SVC. Echocardiogram revealed that the
position of the two ventricles was reversed so that the RA connected to the left ventricle
(LV) and the left atrium (LA) connected to the right ventricle (RV). The aorta arose
from the RV and the pulmonary artery arose from the LV (Fig B). Chest CTA revealed
atrioventricular (AV) and ventriculoatrial (VA) discordance with the morphological LV
in the right side and morphological RV in the left side and interrupted IVC with azygos
continuation (Fig C). Abdomen CTA revealed situs ambiguous with polysplenia. He
had a DDD pacemaker implanted via the left subclavian vein (Fig D) and has been
followed up without any problems ever since. As for the pathomechanisms of CAVB in
this patient, it is possible that conducting pathways in the heart have become thin and
fragile owing to the reversal of the ventricles and may not conduct electrical impulses
around the heart normally. This could, therefore, increase the chance of interruption of
the electrical impulses before they reach the bottom of the ventricles. This is our first
experience of pacemaker implantation in a patient with congenitally corrected
transposition of the great arteries.
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B
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