Long-term function of the morphologic right ventricle in adult patients with corrected transposition of the great arteries

Dimas, Alexios P.; Moodie, Douglas S.; Sterba, Richard; Gill, Carl C.

doi:10.1016/0002-8703(89)90268-8

Cited by 107 publications

(42 citation statements)

References 10 publications

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“…SV, systemic right ventricular function, and exercise performance either worsened 20,21 or did not significantly change with increased age. 22 Taking these findings into account, the slightly older age of the ccTGA patients in our study might have caused the SV to be impaired compared with the atrial switch patients, but as this was not the case we do not think that the age of the ccTGA patients was a factor.…”

Section: Study Limitationsmentioning

confidence: 65%

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

Fratz

Hager

Busch³

et al. 2008

Circ J

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Consecutive outpatients who had undergone the atrial switch operation or who had ccTGA without previous heart surgery were invited to participate. Patients with a permanent pacemaker in situ were excluded. All patients received routine clinical evaluation in the outpatient clinic, including determination of the grade of tricuspid regurgitation by echocardiography. The degree of tricuspid regurgitation was qualitatively assessed by color Doppler imaging and graded as 0 (no regurgitation), I (mild regurgitation), II (moderate Circ J 2008; 72: 1130 -1135 (Received July 1, 2007 revised manuscript received February 6, 2008; accepted February 25, 2008 Background Patients after atrial switch operation for transposition of the great arteries have limited exercise performance. Rigid atrial baffles may cause a relative preload reduction. Previous studies have had suboptimal control groups, which ideally should consist of patients with congenitally corrected transposition of the great arteries (ccTGA) without previous heart surgery, having a systemic right ventricle, but lacking rigid atrial baffles. Therefore the aim of this study was to test the impact of atrial baffles by comparing 12 atrial switch patients with 11 ccTGA patients. Methods and ResultsSystemic right ventricular stroke volume (SV), heart rate, cardiac index, and other parameters were assessed during rest and dobutamine stress magnetic resonance imaging. The most important difference between the groups was that the atrial switch patients could not increase SV during stress, whereas ccTGA patients increased it significantly. There was no difference between groups in the rise of the cardiac index. Heart rate increased significantly more in atrial switch patients than in ccTGA patients. ConclusionsThe results support the hypothesis that atrial baffles restrict a rise in SV under dobutamine stress in patients after atrial switch operation for transposition of the great arteries. (Circ J 2008; 72: 1130 -1135

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Section: Study Limitationsmentioning

confidence: 65%

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

Fratz

Hager

Busch³

et al. 2008

Circ J

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“…Among these features is the propensity for atrioventricular conduction abnormalities 12 and for TV dysfunction [1][2][3] as well as the much-debated capability of the RV to function adequately in the systemic circulation over the course of a normal life span, regardless of the state of the TV. [13][14][15][16] Several investigators have reported that TV function in patients with CTGA appears to be adversely affected by surgical repair of associated lesions. 2,3,7,8 Anatomic distortion of a structurally abnormal TV by VSD closure has been implicated, 7 as has annular dilation after cardiopulmonary bypass-induced RV dysfunction or large preoperative leftto-right shunts.…”

Section: Discussionmentioning

confidence: 99%

Progressive Tricuspid Valve Disease in Patients With Congenitally Corrected Transposition of the Great Arteries

et al. 1998

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Background-The outcome of patients with corrected transposition of the great arteries (CTGA) is variably affected by associated intracardiac defects, tricuspid valve competence, and systemic right ventricular (RV) function. The relative importance of these factors in long-term outcome has not been evaluated. Methods and Results-Since 1958, 40 patients with CTGA were studied to determine risk factors for poor outcome,including age, open heart surgery, tricuspid insufficiency (TI), cardiac rhythm, pulmonary overcirculation, and RV dysfunction. Follow-up ranged from 7 to 36 years (mean 20 years). Intracardiac repair was performed in 21 patients; 19 were unoperated or had closed heart procedures. For the purposes of this study the designation TI s refers to at least moderately severe TI as delineated by echocardiogram and/or angiography. TI s was the only independently significant factor for death (Pϭ0.01), and in turn, only the presence of a morphologically abnormal TV predicted TI s (Pϭ0.03). Twenty-year survival without TI s was 93%, but only 49% with TI s . Poor long-term postoperative outcome was due to TI s in all but 1 patient; 20-year survival rates for operated patients with and without TI s were 34% and 90%, respectively (Pϭ0.002). Similarly, 20-year survival rates for unoperated patients with and without TI s were 60% and 100%, respectively, whether or not attempts to repair the TI were made (Pϭ0.08). Conclusions-TI s represents the major risk factor for CTGA patients; RV dysfunction appears to be almost always secondary to long-standing TI. Decisions related to surgical interventions with or without associated lesions must be strongly influenced by the status of the tricuspid valve. (Circulation. 1998;98:997-1005.)

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“…Given that patients without significant associated intracardiac lesions could remain asymptomatic for a long period,1, 2, 3, 4, 5 these patients can be unrecognized until their adulthood, especially in developing countries like China. Meanwhile, even if they are diagnosed in early childhood, more surgeons tend not to intervene surgically in the absence of hemodynamic lesions, but closely monitor them instead 6, 7.…”

Section: Introductionmentioning

confidence: 99%

Long‐Term Outcomes of Tricuspid Valve Surgery in Patients With Congenitally Corrected Transposition of the Great Arteries

Deng

Tang

et al. 2018

JAHA

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BackgroundValvuloplasty is generally considered unsuccessful in patients with congenitally corrected transposition of the great arteries. Optimal timing of tricuspid valve surgery in these patients is crucial.Methods and ResultsWe retrospectively reviewed 57 patients with congenitally corrected transposition of the great arteries undergoing tricuspid valve surgery at our institution. Eleven patients had tricuspid valve plasty and 46 had tricuspid valve replacement. Mean duration of follow‐up was 7.4±5.5 years in the group of tricuspid valve plasty and 5.6±3.6 years in the group of tricuspid valve replacement, respectively (P=0.33). For the total of 57 patients, estimates of 1‐, 5‐, and 10‐year survival or freedom from transplantation were 96.4%, 91.6%, and 75.6%, respectively. Late right ventricular ejection fraction of most patients (90%) remained preserved (≥40%) during the follow‐up. In a highly selected group of tricuspid valve plasty recipients, although long‐term survival and right ventricular function were similar compared with tricuspid valve replacement, recurrent tricuspid regurgitation was observed in 60% of these patients. Multivariate Cox regression analysis identified preoperative right ventricular end‐diastolic dimension (1‐cm increment; harzard ratio, 3.22; P=0.02) as an independent predictor of postoperative mortality or need for transplantation. Patients undergoing surgery with a right ventricular end‐diastolic dimension ≥60 mm had a significant lower survival rate compared with those with a right ventricular end‐diastolic dimension <60 mm (P=0.003).ConclusionsTricuspid valve surgery in patients with congenitally corrected transposition of the great arteries could yield satisfactory long‐term outcomes. Recurrent tricuspid regurgitation was frequently observed in tricuspid valve plasty recipients. Preoperative right ventricular end‐diastolic dimension was a risk factor for late mortality and surgery should be performed before cardiac enlargement and dysfunction for best outcomes.

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Long-term function of the morphologic right ventricle in adult patients with corrected transposition of the great arteries

Cited by 107 publications

References 10 publications

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

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

Progressive Tricuspid Valve Disease in Patients With Congenitally Corrected Transposition of the Great Arteries

Long‐Term Outcomes of Tricuspid Valve Surgery in Patients With Congenitally Corrected Transposition of the Great Arteries

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