The Triple Threat: A Rare Cause of Heart Failure

Document Type

Conference Proceeding

Publication Date

4-2-2024

Publication Title

Journal of the American College of Cardiology

Abstract

Background: L-type transposition of the great vessels (L-TGA) is a congenital anomaly that is associated with anomalous coronary arteries. Here we present a unique case of L-TGA complicated by obstructive CAD and a malignant anomalous coronary artery presenting as new onset heart failure. Case: A 66-year-old male presented to the emergency department from his primary care provider’s office with chest pain and dyspnea. He was found to have an NSTEMI. Coronary angiography showed anomalous origin of the left coronary system from the right aortic cusp with three-vessel obstructive CAD. Surface echocardiogram showed L-TGA and a dilated systemic ventricle with an ejection fraction of 45%. Coronary CTA confirmed diffuse CAD with anomalous anatomy including a malignant course of the left circumflex artery between the great vessels. Decision-making: The patient was transferred to a tertiary care center for advanced therapies. Right heart catheterization showed a low cardiac index. Cardiac MRI showed transmural infarct of the septum with a systemic ventricle ejection fraction of 35%. After a heart team discussion, he was ineligible for CABG due to his anomalous coronaries and a small systemic ventricle excluded him from ventricular assist device implantation. He was then optimized with GDMT and was discharged with plans for heart transplant evaluation. Conclusion: This case represents a novel description of anomalous coronary anatomy complicated by a malignant course and severe CAD in an adult patient with L-TGA.

Volume

83

Issue

13 Suppl

First Page

3228

Comments

American College of Cardiology 73rd Annual Scientific Session & Expo, April 6-8, 2024, Atlanta, GA

DOI

10.1016/S0735-1097(24)05218-5

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