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CardioNerds (Dr. Josh Saef,\xa0Dr. Agnes Koczo) join Dr. Iva Minga, Dr. Kifah Hussain, and Dr. Kevin Lee from the University of Chicago - NorthShore to discuss a case of unrepaired congenital heart disease that involves D-TGA complicated by Eisenmenger syndrome. The ECPR was provided by Dr. Michael Earing. Audio editing by\xa0Dr. Akiva Rosenzveig.\n\n\n\nA 25-year-old woman with an unknown congenital heart disease that was diagnosed in infancy in Pakistan presents to the hospital for abdominal pain and weakness. She is found to be profoundly hypoxemic, and an echocardiogram revealed D-transposition of the great arteries (D-TGA) with a large VSD. As this was not repaired in childhood, she has unfortunately developed Eisenmenger syndrome with elevated pulmonary vascular resistance. She is stabilized and treated medically for her cyanotic heart disease. Unfortunately given the severity and late presentation of her disease, she has limited long-term options for care. CardioNerds discuss the diagnosis of D-TGA and Eisenmenger\u2019s syndrome, as well as long-term management and complications associated with this entity.\n\n\n\n\n\n\n\nUS Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here.\n\n\n\n\n\n\n\n\n\nCardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll\n\n\n\n\n\nCardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!\n\n\n\n\n\n\n\n\n\nCase Media - Unrepaired Congenital Heart Disease\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPearls - Unrepaired Congenital Heart Disease\n\n\n\n\nEarly diagnosis of cyanotic congenital heart disease is paramount for treatment and prevention of future complications.\n\n\n\nAdult congenital heart disease requires a multi-disciplinary team for management in consultation with an adult congenital cardiology specialist.\n\n\n\nEisenmenger syndrome is related to multiple systemic complications and has a high rate of mortality.\n\n\n\nAdvancement in PAH medical management can offer noninvasive treatment options for some patients.\n\n\n\nTransthoracic echocardiography is the cornerstone for diagnosis. Other modalities (e.g. cardiac CT, cardiac MRI, invasive catheterization) can aid in diagnosis and management.\n\n\n\n\nShow Notes - Unrepaired Congenital Heart Disease\n\n\n\nCyanotic congenital heart disease is often diagnosed in infancy and timely treatment is paramount. As these diseases progress over time, pulmonary over-circulation often pulmonary hypertension (PH), elevated pulmonary vascular resistance, and Eisenmenger syndrome will develop, which preclude definitive treatment. For D-TGA, before PH develops, there are surgical options such as the arterial switch procedure that can treat the disease. Unfortunately, once Eisenmenger syndrome develops, there are multiple systemic complications including hyperviscosity, thrombosis, bleeding, kidney disease, iron deficiency, arrhythmias, etc. that can occur. Management requires a multi-disciplinary team including an adult congenital cardiology specialist, but mortality rates remain high, with median survival reduced by 20 years, worse with complex cardiac defects. Bosentan is a first line treatment for patients with Eisenmenger syndrome, with PDE-5 inhibitors as a second line either by themselves or in combination with bosentan. Data are currently limited for latest-generation PH treatments in Eisenmenger syndrome and further study is still underway.\n\n\n\n\n\nReferences \n\n\n\n\nFerencz C. Transposition of the great vessels. Pathophysiologic considerations based upon a study of the lungs. Circulation. 1966 Feb;33(2):232-41.\n\n\n\nArvanitaki A, Gatzoulis MA, Opotowsky AR, Khairy P, Dimopoulos K, Diller GP, Giannakoulas G, Brida M, Griselli M, Gr\xfcnig E, Montanaro C, Alexander PD, Ameduri R, Mulder BJM, D'Alto M. Eisenmenger Syndrome: JACC State-of-the-Art Review. J Am Coll Cardiol. 2022 Mar 29;79(12):1183-1198.\n\n\n\nEaring MG, Webb GD. Congenital heart disease and pregnancy: maternal and fetal risks. Clin Perinatol.