Heart failure in a patient with corrected transposition of the great arteries. When is biventricular pacing indicated?

This report presents a patient with complex congenitally corrected transposition of the great arteries (ccTGA) and concomitant ventricular septal defect (VSD), who developed symptomatic heart failure further aggravated after dual-chamber pacemaker implantation. The initial disqualification from surgery based on high vascular pulmonary resistance was verified in repeated catheterization. The oxygen test was positive, therefore the patient underwent surgical correction. Despite successful repair with the use of two prosthetic valves (mechanical and biological) and an intraventricular patch, the symptoms of heart failure persisted. In view of the prolonged QRS complex on the ECG and the signs of significant intraventricular mechanical dyssynchrony measured by Tissue Doppler Imaging (TDI), the patient was referred for cardiac resynchronization therapy (CRT). A biventricular pacemaker allowed a larger synchronicity of systemic RV systolic function and the improvement of the patient's general condition. The case described indicates that optimal care in patients with ccTGA can require implementation of both surgical and electrophysiological methods of treatment.