Heart failure (HF) is a major cause of significant morbidity, mortality, and hospitalization worldwide including the Philippines. Congenitally corrected transposition of the great arteries (C-TGA) occurs when the right atrium enters the morphological left ventricle which gives rise to the pulmonary artery and the left atrium communicates with the right ventricle which gives rise to the aorta. Heart failure can occur in C-TGA especially if associated with other heart defects. Ideal management is anatomic correction via surgery to prevent or address heart failure. Peritoneal dialysis has been used as a therapeutic intervention for patients with refractory heart failure and kidney injury with or without kidney failure due to its gentler fluid removal compared to conventional ultrafiltration resulting in less myocardial stunning and neurohormonal activation. We present the case of a patient with heart failure who started on peritoneal dialysis (PD) as an adjunct therapy for fluid management after failing to satisfactorily achieve volume control with diuretics. The patient is a 56-year-old man with C-TGA admitted for decompensated heart failure. He was initially treated with intravenous diuretics on the first admission but was readmitted after 3 months for decompensation this time with borderline low blood pressure making diuresis difficult. The patient was given loop diuretics, tolvaptan, and angiotensin receptor neprilysin inhibitor (ARNI) but still with decreasing trends in urine output and inadequate symptom control. PD was initiated before discharge with subsequent improvement in heart failure symptoms. The patient was on regular follow-up for PD maintenance and titration of heart failure medication. In this case report, we have shown how PD can be an effective adjunct to guideline-directed medical therapy in patients with severely symptomatic heart failure who have an unstable hemodynamic status and for which volume management cannot be satisfactorily achieved with diuretics.
peritoneal dialysis ; heart failure ; congenital heart disease ; congenitally corrected transposition of the great arteries ; diuresis ; ultrafiltration

INTRODUCTION: Hemostasis of the radial artery after transradial coronary procedure can be achieved either manually by means of a gauze or through a device compression band, and radial artery occlusion (RAO) is one of its common complications. The study sought to compare the occurrence of RAO between the two hemostasis methods being used after a transradialcoronary procedure. METHODS: This was a prospective, randomized, open-label, blinded endpoint study. A total of 137 patients undergoing a transradial coronary procedure were randomized equally using block randomization sampling technique. Radial artery patency was evaluated by color duplex ultrasonography within 24 to 72 hours after the procedure. The primary endpoint was early RAO. Secondary endpoints included complications such as access-site bleeding, pain, and hematoma. RESULTS: Three (2.19%) early RAOs occurred: one (1.47%) in the band compression device group and two (2.9%) in the manual gauze compression group (P = 1.000). There were no significant differences between the two groups regarding access-site bleeding (type 1 bleeding, 3 [4.48%] vs 2 [2.90%]; P = 0.678), pain (median pain score of 0 [0–6] vs 0 [0–7]; P = 0.742), and hematoma (grade I: 3 [4.41%]vs 2 [2.9%]; grade II: 0 vs 2 [2.9%]; grade III: none, and grade IV: 0 vs 2 [2.9%]) (P = 0.363). DISCUSSION Compression band device and manually applied gauze compression have similar rates of early RAO, access-site bleeding, pain, and hematoma.
Hemostasis