Multimodal Left Ventricular Rehabilitation Enabling Double-Switch Repair in Congenitally Corrected Transposition of the Great Arteries.

Abstract

Background: In congenitally corrected transposition of the great arteries, pulmonary artery banding (PAB) may prepare the morphologic left ventricle (LV) for systemic work before double-switch repair; however, development of ventricular dysfunction threatens candidacy.

Case summary: 2-year-old boy with corrected transposition of the great arteries and Ebstein-like tricuspid valve malformation developed biventricular dysfunction after PAB tightening, atrial septal stenting, and single-site epicardial pacing for heart block. Biventricular resynchronization therapy, heart failure therapy, and PAB loosening restored ventricular function. Pressure-volume analysis demonstrated comparable ventricular contractility, preserved LV diastolic function, and loading tolerance before uncomplicated double-switch repair.

Discussion: Multimodal rehabilitation and serial reassessment may preserve anatomic repair candidacy when reversible dysfunction complicates LV training.

Take-home messages: Ventricular dysfunction during LV preparation warrants evaluation for reversible contributors, including pacing-associated dyssynchrony and excessive pressure loading, before abandonment of anatomic repair. Following multimodal rehabilitation, serial imaging and pressure-volume analysis can assess LV systolic recovery, diastolic reserve, and loading tolerance for systemic work.