Key result
. No new claims.
Why the study?
Treatment strategies remain unestablished for ccTGA cases without VSD or the need for pulmonary artery intervention.
Case Report (n=1)
No
In a pediatric patient with ccTGA, loosening of a pulmonary artery band successfully reversed anatomical left ventricular dysfunction caused by delayed surgery, allowing for a successful double switch operation.
PA band loosening may restore anatomical LV function in ccTGA to enable double switch; hypothesis-generating and requires prospective validation before adoption.
先天性修正大血管転位（ccTGA; congenitally corrected transposition of the great arteries）のうち心室中隔欠損（VSD; ventricular septal defect）や肺動脈への介入の必要のない症例に対する治療方針はいまだ確立されていない．近年，これらのccTGAの三尖弁閉鎖不全（TR; tricuspid regurgitation）の増悪に対して肺動脈絞扼術（PAB; pulmonary artery banding）の有用性が報告されている．これを基に当院の治療戦略として，心内病変のないccTGAの乳幼児期におけるTR増悪例に対して三尖弁逆流の制御および解剖学的修復術（anatomical repair）の選択肢を将来的に残す目的で積極的にPABを施行してきた．そのうえでPAB後，anatomical repairに到達しうる条件を満たした症例に対してダブルスイッチ手術（DSO; Double switch operation）を施行してきた．今回PAB後，一度はDSOの条件を満たしたものの，手術時期の延期に伴い心機能低下をきたし，肺動脈絞扼の緩徐化（PAB loosening）を行うことで心機能の改善が得られ，DSOに到達することができた稀な症例を経験したため報告する．
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Maeno et al. (2026) conducted a case report in Congenitally corrected transposition of the great arteries (ccTGA) with tricuspid regurgitation (n=1). Pulmonary artery banding (PAB) loosening and Double Switch Operation (DSO) was evaluated on Anatomical left ventricular ejection fraction (aLVEF) and successful completion of DSO. Pulmonary artery banding loosening improved anatomical left ventricular ejection fraction from 35.7% to 55.6% in a patient with ccTGA, enabling a successful double switch operation.
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