Long term ventricular performance after intra-atrial correction of transposition: left ventricular filling is the major limitation

Abstract

Objective-To establish the incidence of systolic and diastolic dysfunction of the right and left ventricle in a large cohort of patients after Mustard or Senning operations and to assess changes in the incidence on long term follow up. Design-Postoperative case-control study using radionuclide ventriculography. Ejection fractions, peak filling rates, rapid filling periods and fractions, slow filling periods and fractions, and atrial contraction periods and fractions were studied. Setting-Tertiary care centre, ambulatory and hospital inpatient care. Patients-A convenience sample of 153 patients studied at median age of 6.9 years (median 4.4 years after surgery). In 99 cases another study was available at a median age of 15.3 years (median 13 years after surgery and 8.8 years after the first study). Results-Respective incidences of dysfunction in the first and the second study were as follows: ejection fraction-right ventricle 7.8% and 8.1%, left ventricle 7.2% and 10.1%; peak filling rate-right ventricle 0% and 4.2%, left ventricle 14.3% and 29.5% (p < 0.05); rapid filling periodright ventricle 18.3% and 11.6%, left ventricle 30.2% and 30.5%; slow filling period-right ventricle 4.8% and 3.2%; left ventricle 11.9% and 23.2%; atrial contraction period-right ventricle 0.8% and 4.2%, left ventricle 15.1% and 26.3%; rapid filling fraction-right ventricle both 0%, left ventricle 82.5% and 79.0%; slow filling fraction-right ventricle 0.8% and 4.2%, left ventricle 37.3% and 30.5%; atrial contraction fraction-right ventricle both 0%, left ventricle 79.4% and 71.6%. Conclusions-The incidence of systolic ventricular dysfunction is 8% (right ventricle) and 10% (left ventricle) 13 years after surgery, without a significant increase over the eight year follow up. Diastolic filling is abnormal in up to 80% of patients and left ventricular peak filling rate deteriorates with time.

Senning operation for correction of the transposition of the great arteries, results, long-term outcome and quality of life

“…The RV variability in assessing right ventricular function and the lack of a uniform definition restrict comparison. The incidence of RV dysfunction in the long term has been shown to be associated with the complexity of the heart defect, [2][3][4]17], which we confirmed by Lange et al [12] that this dysfunction progressed to moderate dysfunction, but maintaining the functional class II.…”

“…In 40 consecutive operations, we had one death (hospital mortality = 2.5%); these results are possible to compare to others reported series, with mortality ranging from 2% to 5.4% [7,8,12,17]. Whereas, patients with simple TGA submitted to Senning's operation, resulted in a significant difference in the relative number of complex TGA.…”

Prognostic Value of Plasma B-Type Natriuretic Peptide in the Long-Term Follow-up of Patients With Transposition of the Great Arteries With Morphologic Right Systemic Ventricle After Atrial Switch Operation

“…38 The incidence of rhythm disturbances (atrial flutter) was lower in the group of patients after Senning repair, and diastolic function was impaired in the majority of patients after Mustard repair, because abnormal ventricular filling may be due, in part, to flow limitation by the atrial baffle. 39, 40 In the present study the female patients had higher BNP, but the difference was not statistically significant. The data extend previous knowledge that BNP is significantly higher in women.…”

Presence of a Ventricular Septal Defect and the Mustard Operation Are Risk Factors for Late Mortality After the Atrial Switch Operation

“…The incidence of moderate or severe RVD shows a wide variation in the literature from 8% at 12 to 18 years 34,35 to 20% and 18% at 20 and 28 years, 12,17 respectively. Kirjavainen et al 11 found a rapid increase of RVD after 10 years and described the probability of normal right ventricular function to be only 52% and 39% 15 years after the Senning procedure in patients with simple and complex TGA, respectively.…”