Evaluation of myocardial function in pediatric patients with transposition of great arteries after arterial switch operation

Abstract

Objective:An arterial switch operation converts the left ventricle (LV) into the systemic ventricle, replacing the right ventricle (RV), which is the systemic ventricle during the prenatal period. The procedure is performed in patients with arterial transposition and those in whom a coronary reimplantation procedure is performed. Therefore, the adaptation of LV and RV to the arterial switch operations is an interesting issue. This study aimed to evaluate systolic and diastolic functions in the LV and RV myocardium using echocardiography in pediatric patients with transposed great arteries after an arterial switch operation.Methods:This observational case control study included 28 patients and 20 gender-and age-matched healthy controls. A group study was performed using patients who were followed for at least 6 months after the operation and who visited the pediatric cardiology outpatient between October 2009 and May 2011. Systolic and diastolic parameters, LV and RV myocardial performance index (MPI) values, and left atrium (LA) volume index were assessed in both groups.Results:The LV MPI and tricuspid valve (TV) E/Ea ratio measured using pulsed-wave Doppler were higher in the patient group than in the control group. The TV E/A ratio and late velocity of lateral mitral annulus (Aa) and systolic velocity (Sa)-early diastolic velocity (Ea)-late velocity (Aa) of the septal mitral annulus and systolic velocity (Sa)-early diastolic velocity (Ea)-late velocity (Aa) of the lateral tricuspid annulus were lower in the patient group than in the control group.Conclusion:Considering the present study’s findings obtained during short-to mid-term follow-up, the RV tissue Doppler flows and the LV MPI were found impaired.

Myocardial performance after coronary re-implantation in pediatric patients assessed with conventional echocardiographic and 2D-speckle tracking analysis: a case-control study

“…[ 21 ] also demonstrated decreased global systolic LV function by magnetic resonance imaging at 16-year follow-up after ASO, suggesting that our findings, such as previous studies, might represent a slight beginning dysfunction that eventually may become apparent by standard measurements of the LV function. The RV conventional Doppler flows, tissue Doppler flows and LV performance were also impaired during the short-to mid-term follow-up of the pediatric patients who underwent ASO [ 22 ].…”

Evaluation of myocardial function in pediatric patients with the transposition of great arteries after arterial switch operation

“…Of note, myocardial dysfunction of either the left or right ventricle (LV and RV) after ASO is another point of concern, because current consensus regarding the appropriate interval and modality for surveillance imaging is lacking, whereas the consequences or management strategy after subtle anatomic or physiologic abnormalities are identified, are yet to be defined. For this reason, the paper entitled “Evaluation of myocardial function in pediatric patients with the transposition of great arteries after arterial switch operation” by Öner et al ( 4 ) published in the current issue of Anatolian Journal of Cardiology is of potential interest. In this observational case control study, authors included 28 pediatric patients who have undergone ASO (followed at least 6 months after the operation), as well as an age and gender matched group ( 4 ).…”

“…For this reason, the paper entitled “Evaluation of myocardial function in pediatric patients with the transposition of great arteries after arterial switch operation” by Öner et al ( 4 ) published in the current issue of Anatolian Journal of Cardiology is of potential interest. In this observational case control study, authors included 28 pediatric patients who have undergone ASO (followed at least 6 months after the operation), as well as an age and gender matched group ( 4 ). Various functional indices of LV and RV, acquired by “classic” and tissue Doppler echocardiography have been implemented with the authors concluding that LV myocardial performance index (MPI) and the RV tissue Doppler indices appear “impaired” compared to the control group, suggesting that even after short-to mid-term follow-up, systolic and diastolic function of both ventri- cles are at least “altered” compared to the normal controls ( 4 ).…”