Abstract
Cardiac resynchronization therapy (CRT) is a new treatment for refractory heart failure. However, most heart failure patients treated with CRT are middle-aged or old patients with idiopathic or ischemic dilated cardiomyopathy. We treated a 17 year 11 month old girl with dilated cardiomyopathy after mitral valve replacement (MVR) and septal anterior ventricular exclusion (SAVE). Seven years after the SAVE procedure, she presented complaining of palpitations and general fatigue with normal activity. Her echocardiogram showed reduced left ventricular function. Despite of optimal medical therapy, her left ventricular function continued to decline and she experienced regular arrhythmias such as premature ventricular contractions. We thus elected to perform cardiac resynchronization therapy with defibrillator (CRT-D). After CRT-D, her clinical symptoms improved dramatically and left ventricular ejection fraction (LVEF) improved from 31.2% to 51.3% as assessed by echocardiogram. Serum BNP levels decreased from 448.2 to 213.6 pg/ml. On ECG, arrhythmias were remarkably reduced and QRS duration was shortened from 174 to 152 msec. In conclusion, CRT-D is an effective therapeutic option for adolescent patients with refractory heart failure after left ventricular volume reduction surgery.
Highlights
Left ventricular volume reduction therapy has been an effective treatment modality for end-staged dilated cardiomyopathy
cardiac resynchronization therapy (CRT) has resulted in significant improvements in the quality of life, functional class, exercise tolerance, and ejection fraction [2,3,4,5] in patients with refractory heart failure
Three months after the cardiac resynchronization therapy with defibrillator (CRT-D) implantation, the left ventricular ejection fraction (LVEF) improved from 31.2% to 51.3% (Figure 3) and the serum BNP levels decreased from 448.2 to 213.6 pg/ml
Summary
Left ventricular volume reduction therapy has been an effective treatment modality for end-staged dilated cardiomyopathy. More than 4000 heart failure patients with ventricular asynchrony have been evaluated in randomized controlled trials of optimal medical therapy alone versus optimal medical therapy plus CRT. Case Presentation In December 2009, a 17 year, 11 month old adolescent girl with history of worsening dilated cardiomyopathy after mitral valve replacement (MVR) and septal anterior ventricular exclusion (SAVE) was admitted to our hospital for the evaluation for cardiac resynchronization therapy (CRT).
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