講演情報
[II-TSPCJS-1]Hemodynamic Assessment by Catheterization in the Management of Patients with TGA after Atrial Switch
○Ayako Ishikita1, Tomoyasu Suenaga1, Akiko Nishizaki1, Takamori Kakino1, Ichiro Sakamoto1, Eiko Terashi2, Kenichiro Yamamura2, Kohtaro Abe1 (1.Department of Cardiovascular Medicine, Kyushu University Hospital, 2.Department of Pediatrics, Kyushu University Hospital)
キーワード：
Systemic RV、GDMT、pulmonary hypertension
Systemic RV dysfunction and concomitant pulmonary hypertension (PH) are important prognostic factors in patients with transposition of the great arteries (TGA) after atrial switch, but their management has not been standardized. Here, we present our practice based on hemodynamic assessment by catheterization. Patients with RV dysfunction are treated with medical therapy (GDMT) according to current heart failure (HF) guidelines; response to GDMT varied as shown below:Case1. A 37-year-old man presented with HF and severe TR. Initially, TVR for severe TR was not indicated due to combined pre- and post-capillary PH (mean PAP 64mmHg, PCWP 17mmHg, and PVR 13w.u.). After GDMT, PH was improved (mean PAP 22mmHg, PCWP 11mmHg, and PVR 2.0w.u.). TVR was subsequently performed, and the patient is now NYHA Class I.Case2. A 35-year-old man presented with HF, but no PH. HF symptoms were controlled with maximal GDMT. However, routine catheterization 3 years after starting GDMT revealed postcapillary PH (PCWP 22mmHg, mean PAP 28mmHg, and PVR 2.8w.u.). He was registered as a recipient for heart transplantation. Now he is waiting for heart transplant with support by aRVAD.Case3. A 48-year-old woman presented with severe TR, combined pre- and post-capillary PH (mean PAP 80mmHg, PCWP 30mmHg, PVR 14.0w.u). Despite maximal GDMT, clinical improvement was limited (mean PAP 60mmHg, PCWP 21mmHg, PVR 4.7w.u). In severe PH, additional surgical intervention or heart transplantation was contraindicated.Repeated evaluation by catheterization is a valuable in the management of TGA after atrial switch.