Cardiologie clinique et expérimentale
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Complete Atrio-Ventricular Block with Atrio-Ventricular and Ventriculo-Arterial Discordance in Adults: About a Case

Serigne Mor Beye*, Y Diouf, Alioune Tabane, Fatou Aw, Khadimu Rassoul Diop, Malick Bodian, Adama Kane

Introduction

The double atrioventricular and ventriculoarterial discordance is characterized by an aberrant connection between a right atrium and a ventricle of left morphology, from which anterior ventricle emerges a dividing vessel: the pulmonary artery. From the left ventricle with right morphology emerges a large vessel not dividing, the aorta. It is a rare congenital heart disease that can be associated with disorders of atrioventricular conduction.

Case report

It was a 45-year-old patient with no cardiovascular risk factors and no pathological history. He had a dyspnea of progressive worsening for two months initially at the usual efforts to then become a respiratory gene at the least effort. He did not report any notion of chest pain, dizziness or loss of consciousness. At admission, blood pressure was 150/60 mmHg with bradycardia at 40 beats / min, polypnea at 26 cycles / min and oxygen saturation at room air at 96%. The physical examination noted a right ventricular paraesternal heave and fine crackles at the pulmonary bases.

The EKG enrolled a complete atrioventricular block with narrow QRS complex and right atrial hypertrophy. Transthoracic ultrasonography showed atrioventricular and ventriculoarterial discordance with significant dilation of the left atrium and preserved biventricular systolic function.

A double chamber pacemaker implantation was performed. The ventricular lead was placed in the left ventricle instead of the right ventricle. We associated Spirinolactone and Ramipril in the treatment. The evolution was favorable with a considerable regression of the dyspnea two weeks after the pacemaker implantation.

Conclusion

Double atrioventricular and ventriculoarterial discordance is a rare congenital anomaly. It can induce disorders of atrioventricular conduction and compromise the functional and vital prognosis. Hence the need for implantation of a pacemaker.