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

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.