Letter to the Editor Left Ventricular Assist Device Implantation in a Patient With Congenitally Corrected Transposition of the Great Arteries To the Editor, Left ventricular assist device (LVAD) implanta- tion in cases of congenital heart disease remains high risk and should only be performed in high-volume LVAD centers by experienced surgeons. Congeni- tally corrected transposition of the great arteries (ccTGA) is a rare cardiac anomaly in which late hemodynamic deterioration and ventricular dysfunc- tion affect survival. We report the case of a successful LVAD implantation in a 58-year-old woman with ccTGA complicated with rapidly deteriorating con- dition despite optimal medical treatment and lack of other interventional options. ccTGA is a rare cardiac anomaly featuring discor- dant ventriculo-arterial connection (1). In this condi- tion, the right atrium is connected to the left ventricle (LV) and the left atrium (LA) is connected to the right ventricle (RV), hence circulatory pathways are in series. Late hemodynamic pathologies involve sys- temic RV failure, failure of atrioventricular valves, and late pulmonary hypertension. Survival correlates closely with deterioration of ventricular function (1,2). Surgical options involve atrioventricular valve replacement, pulmonary artery banding to improve RV/LV interaction, anatomic repair with the “double-switch” operation, and cardiac transplanta- tion. We report here the successful use of LVAD implantation in a patient with ccTGA suffering from end-stage heart failure (HF). CASE PRESENTATION A 58-year-old woman (150 cm, 65 kg, body mass index [BMI] 29 kg/m 2 ) was admitted for recurrent cardiac decompensation secondary to end-stage HF. The patient had been diagnosed with asymptomatic ccTGA at the age of 44 at a routine examination. In 2008, the patient began experiencing recurrent cardiac decompensation, with ascites, recurrent lung edema, pleural effusion requiring drainage, and mul- tiple hospitalizations. Comorbidities included atrial fibrillation, type II diabetes, arterial hypertension, and hypothyroidism. The patient complained of severe dyspnea and decreased physical capacity, with 6-min walking distance decreasing progressively to 100 m and New York Heart Association (NYHA) functional classification of III. Right-heart catheterization in April 2012 showed reduced cardiac index (CI) under recompensated conditions (1.94 L/min/m 2 ; cardiac output 3.07 L/ min) and pulmonary hypertension (pulmonary vas- cular resistance [PVR]: 213 dyn·s/cm 5 ). In July 2013, after another episode of cardiac decompensation, catheterization showed worsening function (CI 1.8 L/ min/m 2 ; cardiac output 3.07 L/min) and increased pulmonary hypertension (PVR 347 dyn·s/cm 5 ). Coro- nary catheterization showed no significant coronary sclerosis. Transthoracic echocardiography showed severe, progressive reduction in the systolic function of the functional LV, from an ejection fraction (EF) <25% in June 2012 to <15% in June 2013. The functional RV showed an EF of 35% in 2012 and 40% in 2013. The heart was bi-atrially dilated, with mitral and mild tricuspid (systemic) valve regurgitation; it showed also no ventricular septal defect, and no pulmonary valve stenosis (Figs. 1 and 2). Because of her rapidly deteriorating condition despite optimal medical treatment and lack of other interventional options, an interdisciplinary team dis- cussed pulmonary banding; we had a similar case doi:10.1111/aor.12506 FIG. 1. Preoperative chest x-ray showing marked cardiomegaly with aorta to the right side. Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc. Artificial Organs 2015, 39(12):1069–1071