Is the Lecompte technique the last word on transposition of the great arteries repair for all patients? A magnetic resonance imaging study including a spiral technique two decades postoperatively

Rickers, Carsten; Kheradvar, Arash; Sievers, Hans‐Hinrich; Falahatpisheh, Ahmad; Wegner, Philip; Gabbert, Dominik Daniel; Jerosch‐Herold, Michael; Hart, Chris; Voges, Inga; Putman, Léon M.; Kristo, Ines; Fischer, G.; Scheewe, Jens; Kramer, Hans‐Heiner

doi:10.1093/icvts/ivw014

Cited by 25 publications

(28 citation statements)

References 27 publications

(41 reference statements)

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“…31 Although not frequently applied worldwide and technically not applicable for every TGA patient, the results from in vivo 4D flow studies in these patients 20 years after ASO reported more physiological aortic blood flow in the great arteries compared with patients who underwent a Lecompte procedure during ASO. 32 These results, together with the results of this study, in which we showed the presence of abnormal aortic flow hemodynamics in young patients after ASO, suggest aortic geometry as an important factor for altered flow hemodynamics. Although aortic geometry seems to contribute to altered flow hemodynamics, due to the measurements at a single timepoint, it is unknown if the altered FD and WSS are the result of progressive aortic dilatation, or if in any way these altered hemodynamics were causative of the dilatation.…”

Section: Discussionsupporting

confidence: 77%

“…In this regard, an alternative surgical technique has been described for TGA that preserves a more physiologic spiral anatomy of the great arteries, without applying the Lecompte maneuver . Although not frequently applied worldwide and technically not applicable for every TGA patient, the results from in vivo 4D flow studies in these patients 20 years after ASO reported more physiological aortic blood flow in the great arteries compared with patients who underwent a Lecompte procedure during ASO . These results, together with the results of this study, in which we showed the presence of abnormal aortic flow hemodynamics in young patients after ASO, suggest aortic geometry as an important factor for altered flow hemodynamics.…”

Section: Discussionmentioning

confidence: 99%

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Altered Ascending Aorta Hemodynamics in Patients After Arterial Switch Operation for Transposition of the Great Arteries

Palen

Deurvorst

Kroft

et al. 2019

Magnetic Resonance Imaging

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Background Patients with transposition of the great arteries (TGA) have an altered aortic geometry after an arterial switch operation (ASO), with neo‐aortic root dilatation as an important complication. Geometry‐related aortic hemodynamics have been assumed to contribute to pathology of the ascending aorta (AAo). Purpose To evaluate aortic flow displacement (FD) and regional wall shear stress (WSS) in relation to ascending neo‐aortic geometry in children after ASO. Study Type Prospective. Population Twenty‐eight TGA patients after ASO and 10 healthy volunteers. Field Strength/Sequence 3.0T/4D flow (segmented fast‐spoiled echo pulse), noncontrast‐enhanced MR angiography (Dixon), and anatomic images (SSFP). Assessment Aortic diameters and body surface area‐indexed aortic dimensions (Z‐scores), normalized FD and planar ascending aortic WSS. Statistical Tests Mann–Whitney and chi‐square tests for differences in FD magnitude, WSS, and FD directionality between groups, respectively. Spearman rank correlation to assess the degree of association between aortic geometry, FD and WSS parameters. Shapiro–Wilk test to evaluate distribution normality on the absolute differences in octant location between FD and WSS. Results TGA patients showed a significantly dilated proximal AAo and relatively small mid‐AAo dimensions at the level of the pulmonary arteries (Z‐scores neo‐aortic root: 4.38 ± 1.96 vs. 1.52 ± 0.70, P < 0.001; sinotubular junction: 3.48 ± 2.67 vs. 1.38 ± 1.30, P = 0.010; mid‐AAo: 0.32 ± 3.06 vs. 1.69 ± 1.24, P = 0.001). FD magnitude was higher in TGA patients (neo‐aortic root: 0.048 ± 0.027 vs. 0.021 ± 0.006, P < 0.001; sinotubular junction: 0.054 ± 0.037 vs. 0.029 ± 0.013, P < 0.05) and was related to the neo‐aortic Z‐score. Clear areas of higher WSS at the right and anterior aortic wall regions along the distal AAo were detected in TGA patients, most pronounced in those with relatively smaller mid‐AAo diameters. Data Conclusion TGA‐specific geometry related to the ASO, evidenced by neo‐aortic root dilatation and a sudden change in vessel diameter at mid‐AAo level, leads to more aortic flow asymmetry in the proximal AAo and WSS distribution with higher WSS at the right and anterior aortic wall regions along the distal AAo. Level of Evidence: 1 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;51:1105–1116.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Altered Ascending Aorta Hemodynamics in Patients After Arterial Switch Operation for Transposition of the Great Arteries

Palen

Deurvorst

Kroft

et al. 2019

Magnetic Resonance Imaging

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“…The pulmonary trunk position (in relation to the ascending aorta) is also known to play a role on the flow patterns in post-Lecompte cases [13]. All the patients analyzed in this work had an anterior (central) position of the pulmonary trunk, a layout that was found to enhance vortical and helical flow [13], particularly when compared to the spiral arrangement [20]. Based on similar fluid mechanics considerations, an alternative procedure aiming to restore the spiral relationship of the great vessels has been advocated by some authors [19,48], although the Lecompte maneuver remains the standard clinical practice [1].…”

Section: Discussionmentioning

confidence: 92%

Computational Study of Pulmonary Flow Patterns After Repair of Transposition of Great Arteries

Capuano¹,

Loke

Cronin

et al. 2019

Journal of Biomechanical Engineering

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Patients that undergo the arterial switch operation (ASO) to repair transposition of great arteries (TGA) can develop abnormal pulmonary trunk morphology with significant longterm complications. In this study, cardiovascular magnetic resonance was combined with computational fluid dynamics to investigate the impact of the post-operative layout on the pulmonary flow patterns. Three ASO patients were analyzed and compared to a normal control. Results showed the presence of anomalous shear layer instabilities, vortical and helical structures, and turbulent-like states in all patients, particularly as a consequence of the unnatural curvature of the pulmonary bifurcation. Streamlined, mostly laminar flow was instead found in the healthy subject. These findings shed light on the correlation between the post-ASO anatomy and the presence of altered flow features, and may be useful to improve surgical planning as well as the long-term care of TGA patients.

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“…However, the formation mechanisms of these flow patterns were not discussed. A number of computational and imaging studies analyzed the three-dimensional hemodynamics in patients with repaired TGA compared to healthy controls (typically young adults) [16][17][18][19]. Of note, Geiger et al found again right-handed helical flow in the RPA of 8 (out of 12) controls [17].…”

Section: Introductionmentioning

confidence: 99%

Blood Flow Dynamics at the Pulmonary Artery Bifurcation

Capuano

Loke

Balaras

2019

Fluids

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Knowledge of physiologic hemodynamics is a fundamental requirement to establish pathological findings. However, little is known about the normal flow fields in the pulmonary arteries, especially for children. The purpose of this study is to characterize flow patterns in the pulmonary artery bifurcation of healthy pediatric subjects using direct numerical simulations. A realistic geometry is obtained via statistical shape modeling, by averaging five subject-specific digital models extracted from cardiovascular magnetic resonance datasets of healthy volunteers. Boundary conditions are assigned to mimic physiological conditions at rest, corresponding to a peak Reynolds number equal to 3400 and a Womersley number equal to 15. Results show that the normal bifurcation is highly hemodynamically efficient, as measured by an energy dissipation index. The curvature of the pulmonary arteries is sufficiently small to prevent flow separation along the inner walls, and no signs of a turbulent-like state are found. In line with previous imaging studies, a helical structure protruding into the right pulmonary artery is detected, and its formation mechanism is elucidated in the paper. These findings might help to identify abnormal flow features in patients with altered anatomic and physiologic states, particularly those with repaired congenital heart disease.

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Is the Lecompte technique the last word on transposition of the great arteries repair for all patients? A magnetic resonance imaging study including a spiral technique two decades postoperatively

Cited by 25 publications

References 27 publications

Altered Ascending Aorta Hemodynamics in Patients After Arterial Switch Operation for Transposition of the Great Arteries

Altered Ascending Aorta Hemodynamics in Patients After Arterial Switch Operation for Transposition of the Great Arteries

Computational Study of Pulmonary Flow Patterns After Repair of Transposition of Great Arteries

Blood Flow Dynamics at the Pulmonary Artery Bifurcation

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