Complete atrioventricular block in an adult with congenitally corrected transposition of the great arteries with interrupted inferior vena cava
A 56-year-old man presented to Chonnam National University Hospital, Gwangju, Korea, in 2009 with dizziness and chest tightness for 3 days. He was a 30 pack-year current smoker. His blood pressure was 140/90 mmHg and heart rate was 35/min. Grade 1 systolic murmur was audible at the apex. The electrocardiogram (ECG) showed complete AV block with a ventricular beat of 35/min []. Sinus rate was 54/min. Mild cardiomegaly was seen on chest X-ray. Temporary pacemaker was tried via transfemoral approach at first. However, electrode catheter was not advanced into the right ventricle despite several trials. We found that he had no IVC which drained into right atrium. Venous drainage into superior vena cava from dilated azygos vein was identified after venogram []. Thus, an electrode was positioned in the right side ventricle via azygos vein and superior vena cava. Echocardiogram revealed that the position of the two ventricles was reversed resulting in the following: the right atrium connecting to the left ventricle, the left atrium connecting to the right ventricle, also the aorta arising from the right ventricle and supplying systemic circulation, and the pulmonary artery arising from the left ventricle and supplying pulmonary circulation []. Chest computed tomography (CT) angiogram revealed AV and ventriculoarterial discordance with morphologically left ventricle in the right side and morphologically right ventricle in the left side and interrupted IVC with azygos continuation []. Abdomen CT angiogram revealed situs ambiguous with polysplenia. Anyway, he needed permanent pacemaker definitely. Thus, DDD pacemaker was implanted via left axillary vein []. The pacemaker parameter showed ordinary feature. We have followed him up without any problem.