PDF(Pubmed)
Abstract：
A 33-year-old man presented with a 3-week history of breathlessness and cough. He disclosed that he was informed regarding a heart defect as a child in his home country but was unaware of its nature and was never followed up. Examination revealed a pansystolic murmur (loudest at the apex), a hyperdynamic, displaced apex, and pulmonary oedema. An ECG showed atrial fibrillation with a regular broad-complex ventricular rhythm. Following electrical cardioversion, the ECG revealed complete heart block, therefore explaining the regular atrial fibrillation. An urgent transthoracic echocardiography (TTE) confirmed the anatomy of congenitally corrected transposition of the great arteries (CCTGA) with torrential tricuspid regurgitation and impaired systemic right ventricle. Cardiac MRI identified a ventricular septal defect which was not visible on TTE. The patient showed a transient improvement following fluid offloading and ACE inhibition, with a more definitive improvement after cardiac resynchronisation therapy (CRT).
摘要：
一名33岁的男子有3周的呼吸困难和咳嗽病史。他透露，他在自己的祖国小时候就被告知有心脏缺陷，但不知道其性质，从未被跟进。检查显示全收缩期杂音（顶点最大），一个超动态的，移位的顶点，和肺水肿.心电图显示心房颤动伴有规律的广泛复杂的室性节律。电复律后,心电图显示完全心脏传导阻滞,因此解释了常规的心房颤动。紧急经胸超声心动图（TTE）证实了先天性矫正的大动脉转位（CCTGA）伴三尖瓣返流和全身右心室受损的解剖结构。心脏MRI确定了室间隔缺损，在TTE上看不到。患者在液体卸载和ACE抑制后表现出短暂的改善，心脏再同步治疗（CRT）后有更明确的改善。
