Subscribe to RSS
A Comprehensive Functional Analysis in Patients after Atrial Switch SurgeryFunding This study was financially supported by the Fördergemeinschaft Deutsche Kinderherzzentren, Bonn, Germany.
Background Long-term course after atrial switch operation is determined by increasing right ventricular (RV) insufficiency. The aim of our study was to investigate subtle functional parameters by invasive measurements with conductance technique and noninvasive examinations with cardiac magnetic resonance imaging (CMR).
Methods We used invasive (pressure–volume loops under baseline conditions and dobutamine) and noninvasive techniques (CMR with feature tracking [FT] method) to evaluate RV function. All patients had cardiopulmonary exercise testing (CPET).
Results From 2011 to 2013, 16 patients aged 28.2 ± 7.3 (22–50) years after atrial switch surgery (87.5% Senning and 12.5% Mustard) were enrolled in this prospective study. All patients were in New York Heart Association (NYHA) class I to II and presented mean peak oxygen consumption of 30.1 ± 5.7 (22.7–45.5) mL/kg/min. CMR-derived end-diastolic volume was 110 ± 22 (78–156) mL/m2 and RV ejection fraction 41 ± 8% (25–52%). CMR-FT revealed lower global systolic longitudinal, radial, and circumferential strain for the systemic RV compared with the subpulmonary left ventricle. End-systolic elastance (Ees) was overall reduced (compared with data from the literature) and showed significant increase under dobutamine (0.80 ± 0.44 to 1.89 ± 0.72 mm Hg/mL, p ≤ 0.001), whereas end-diastolic elastance (Eed) was not significantly influenced (0.11 ± 0.70 to 0.13 ± 0.15 mm Hg/mL, p = 0.454). We found no relevant relationship between load-independent conductance indices and strain or CPET parameters. Conductance analysis revealed significant mechanical dyssynchrony, higher during diastole (mean 30 ± 4% baseline, 24 ± 6% dobutamine) than during systole (mean 17 ± 6% baseline, 19 ± 7% dobutamine).
Conclusions Functional assessment of a deteriorating systemic RV remains demanding. Conductance indices as well as the CMR-derived strain parameters showed overall reduced values, but a significant relationship was not present (including CPET). Our conductance analysis revealed intraventricular and predominantly diastolic RV dyssynchrony.
Both Andreas Hornung and Daniela Vollmer were involved in data collection and interpretation. Furthermore, D.V. was responsible for the study design and A.H. for writing of the manuscript.
* Both authors contributed equally to this work.
Received: 11 May 2020
Accepted: 25 January 2021
13 April 2021 (online)
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Dos L, Teruel L, Ferreira IJ. et al. Late outcome of Senning and Mustard procedures for correction of transposition of the great arteries. Heart 2005; 91 (05) 652-656
- 2 Apitz C, Latus H, Binder W. et al. Impact of restrictive physiology on intrinsic diastolic right ventricular function and lusitropy in children and adolescents after repair of tetralogy of Fallot. Heart 2010; 96 (22) 1837-1841
- 3 Baan J, van der Velde ET, de Bruin HG. et al. Continuous measurement of left ventricular volume in animals and humans by conductance catheter. Circulation 1984; 70 (05) 812-823
- 4 Steendijk P, Tulner SA, Schreuder JJ. et al. Quantification of left ventricular mechanical dyssynchrony by conductance catheter in heart failure patients. Am J Physiol Heart Circ Physiol 2004; 286 (02) H723-H730
- 5 Dubowy KO, Baden W, Bernitzki S, Peters B. A practical and transferable new protocol for treadmill testing of children and adults. Cardiol Young 2008; 18 (06) 615-623
- 6 Hor KN, Baumann R, Pedrizzetti G. et al. Magnetic resonance derived myocardial strain assessment using feature tracking. J Vis Exp 2011; (48) 2356
- 7 Tutarel O, Orwat S, Radke RM. et al. Assessment of myocardial function using MRI-based feature tracking in adults after atrial repair of transposition of the great arteries: reference values and clinical utility. Int J Cardiol 2016; 220: 246-250
- 8 Paul MH, Wessel HU. Exercise studies in patients with transposition of the great arteries after atrial repair operations (Mustard/Senning): a review. Pediatr Cardiol 1999; 20 (01) 49-55 , discussion 56
- 9 Derrick GP, Narang I, White PA. et al. Failure of stroke volume augmentation during exercise and dobutamine stress is unrelated to load-independent indexes of right ventricular performance after the Mustard operation. Circulation 2000; 102 (19) (Suppl. 03) III154-III159
- 10 Fratz S, Hager A, Busch R. et al. Patients after atrial switch operation for transposition of the great arteries can not increase stroke volume under dobutamine stress as opposed to patients with congenitally corrected transposition. Circ J 2008; 72 (07) 1130-1135
- 11 Budts W, Scheurwegs C, Stevens A, Moons P, Van Deyk K, Vanhees L. The future of adult patients after Mustard or Senning repair for transposition of the great arteries. Int J Cardiol 2006; 113 (02) 209-214
- 12 Vogel M, Derrick G, White PA. et al. Systemic ventricular function in patients with transposition of the great arteries after atrial repair: a tissue Doppler and conductance catheter study. J Am Coll Cardiol 2004; 43 (01) 100-106
- 13 Rahko PS. Comparative efficacy of three indexes of left ventricular performance derived from pressure-volume loops in heart failure induced by tachypacing. J Am Coll Cardiol 1994; 23 (01) 209-218
- 14 Sanz J, García-Alvarez A, Fernández-Friera L. et al. Right ventriculo-arterial coupling in pulmonary hypertension: a magnetic resonance study. Heart 2012; 98 (03) 238-243
- 15 McCabe C, White PA, Hoole SP. et al. Right ventricular dysfunction in chronic thromboembolic obstruction of the pulmonary artery: a pressure-volume study using the conductance catheter. J Appl Physiol (1985) 2014; 116 (04) 355-363
- 16 Latus H, Binder W, Kerst G, Hofbeck M, Sieverding L, Apitz C. Right ventricular-pulmonary arterial coupling in patients after repair of tetralogy of Fallot. J Thorac Cardiovasc Surg 2013; 146 (06) 1366-1372
- 17 Schlangen J, Fischer G, Petko C. et al. Arterial elastance and its impact on intrinsic right ventricular function in palliated hypoplastic left heart syndrome. Int J Cardiol 2013; 168 (06) 5385-5389
- 18 Logoteta J, Ruppel C, Hansen JH. et al. Ventricular function and ventriculo-arterial coupling after palliation of hypoplastic left heart syndrome: a comparative study with Fontan patients with LV morphology. Int J Cardiol 2017; 227: 691-697
- 19 Chen CH, Fetics B, Nevo E. et al. Noninvasive single-beat determination of left ventricular end-systolic elastance in humans. J Am Coll Cardiol 2001; 38 (07) 2028-2034
- 20 Redfield MM, Jacobsen SJ, Borlaug BA, Rodeheffer RJ, Kass DA. Age- and gender-related ventricular-vascular stiffening: a community-based study. Circulation 2005; 112 (15) 2254-2262
- 21 Ky B, French B, May Khan A. et al. Ventricular-arterial coupling, remodeling, and prognosis in chronic heart failure. J Am Coll Cardiol 2013; 62 (13) 1165-1172
- 22 Chow PC, Liang XC, Lam WW, Cheung EW, Wong KT, Cheung YF. Mechanical right ventricular dyssynchrony in patients after atrial switch operation for transposition of the great arteries. Am J Cardiol 2008; 101 (06) 874-881
- 23 Janousek J, Tomek V, Chaloupecký VA. et al. Cardiac resynchronization therapy: a novel adjunct to the treatment and prevention of systemic right ventricular failure. J Am Coll Cardiol 2004; 44 (09) 1927-1931
- 24 Cecchin F, Frangini PA, Brown DW. et al. Cardiac resynchronization therapy (and multisite pacing) in pediatrics and congenital heart disease: five years experience in a single institution. J Cardiovasc Electrophysiol 2009; 20 (01) 58-65
- 25 Kurita T, Onishi K, Dohi K. et al. Impact of heart rate on mechanical dyssynchrony and left ventricular contractility in patients with heart failure and normal QRS duration. Eur J Heart Fail 2007; 9 (6–7): 637-643
- 26 A'roch R, Steendijk P, Oldner A. et al. Left ventricular mechanical dyssynchrony is load independent at rest and during endotoxaemia in a porcine model. Acta Physiol (Oxf) 2009; 196 (04) 375-383
- 27 Claus P, Omar AMS, Pedrizzetti G, Sengupta PP, Nagel E. Tissue tracking technology for assessing cardiac mechanics: principles, normal values, and clinical applications. JACC Cardiovasc Imaging 2015; 8 (12) 1444-1460
- 28 Pettersen E, Helle-Valle T, Edvardsen T. et al. Contraction pattern of the systemic right ventricle shift from longitudinal to circumferential shortening and absent global ventricular torsion. J Am Coll Cardiol 2007; 49 (25) 2450-2456
- 29 Salehi Ravesh M, Rickers C, Bannert FJ. et al. Longitudinal deformation of the right ventricle in hypoplastic left heart syndrome: a comparative study of 2D-feature tracking magnetic resonance imaging and 2D-speckle tracking echocardiography. Pediatr Cardiol 2018; 39 (06) 1265-1275
- 30 Helsen F, De Meester P, Van De Bruaene A. et al. Right ventricular systolic dysfunction at rest is not related to decreased exercise capacity in patients with a systemic right ventricle. Int J Cardiol 2018; 260: 66-71