Sympathetic Denervation and Reinnervation After Arterial Switch Operation for Complete Transposition

Kondo, Chisato; Nakazawa, Makoto; Momma, Kazuo; Kusakabe, Kiyoko

doi:10.1161/01.cir.97.24.2414

Cited by 61 publications

(43 citation statements)

References 30 publications

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“…However, two patients showed signs of denervation of the heart even 30 years after the ASO. This was consistent with the results of a previous study by Kondo et al A denervation of the heart was found early after the ASO and a reinnervation of various degrees later [6]. The present study had some limitations: the small sample size and the HRV which was only measured long time after the surgery.…”

Section: Discussionsupporting

confidence: 91%

“…Changes in heart rate, HRV, and blood pressure are some of the variables that may reflect alterations in the balance between the sympathetic and parasympathetic nervous systems. Sympathetic denervation after TGA has been found early after the ASO, and reinnervation late after the surgery, using metaiodobenzylguanidine [6]. However, HRV is currently the method of choice for clinical assessment of denervation of the heart.…”

Section: Discussionmentioning

confidence: 99%

“…By means of a radiopharmaceutical metaiodobenzylguanidine, denervation of the heart has been found early after the ASO. Although reinnervation of various degrees took place later, this was much more frequent if surgery was performed before 55 days of age [6]. However, radiation exposure should be avoided, especially in children.…”

Section: Introductionmentioning

confidence: 99%

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Noninvasive Assessment of Autonomic Cardiovascular Function in Patients after Arterial Switch Operation for Transposition of the Great Arteries

Hlebowicz¹,

Rooth²,

Lindstedt³

et al. 2015

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Background: Children born with transposition of the great arteries (TGA) must undergo corrective surgery for survival, arterial switch being the standard surgical procedure. The sympathetic innervation of the heart may be damaged during the operation. This study was designed to determine whether adults who were born with TGA and who had arterial switch operation (ASO) in infancy exhibit denervation of the heart, measured as heart rate variability (HRV) with electrocardiography (ECG). Methods: Nine patients with transposition of the great arteries (four men and five women; mean age 26 ± 1 years) who underwent the ASO at a mean age of 85 ± 35 days, and nine healthy adults (five men and five women; mean age 26 ± 2) were included in the study. Cardiac autonomic nerve function was determined by the variation in RR intervals during maximal deep breathing, monitored by continuous ECG. The mean values were calculated for each group from six inspirations (I) and expirations (E), and the E:I ratios were calculated. Results: The E:I ratio did not differ between patients with an arterial switch and healthy controls (P = 0.161). Two patients had signs of denervation of the heart up to 30 years after the arterial switch operation. Conclusions: Reinnervation of the heart may take place in patients who have undergone the ASO in infancy, and these patients would not necessarily suffer from autonomic dysfunction. The HRV, measured by ECG, has the potential to identify arterially switched patients at risk of developing silent myocardial ischemia.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Noninvasive Assessment of Autonomic Cardiovascular Function in Patients after Arterial Switch Operation for Transposition of the Great Arteries

Hlebowicz¹,

Rooth²,

Lindstedt³

et al. 2015

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“…Kondo et al (14) reported that cardiac sympathetic nerves are reinnervated late after arterial switch operation. Similarly, it has been shown that one year after heart transplantation there was increased norepinephrine (NE) uptake, indicating reinnervation of cardiac sympathetic nerves (15).…”

Section: Discussionmentioning

confidence: 99%

“…*:Data are given as median (interquartile range) ‡ :P is calculated with Mann-Whitney U Test HF -power in the high frequency range -high frequency; LF -power in the low frequency range -low frequency; LF/HF -the ratio of low frequency to high frequency; NS -not significant; pNN50% -the percentage of successive normal sinus; R-R intervals longer than 50 milliseconds; rMSSD -root mean square of the successive normal sinus; R-R interval difference; SDNN -standard deviation of all normal sinus R-R intervals; TP -variance of all R-R intervals -total power; VLF -power in the very low frequency range -very low frequency. *:Data are given as median (interquartile range) † :P is calculated with paired samples t-test ‡ :P is calculated with Wilcoxon Signed Ranks Test (14) studied metaiodobenzylguanidine (MIBG) uptake in patients with complete transposition. They hypothesized that the heart was sympathetically denervated shortly after, and reinnervated late after the ASO.…”

Section: Discussionmentioning

confidence: 99%

Mid-term assessment of cardiac autonomic functions in children with transposition of the great arteries after arterial switch operation

Doksöz

Öner²,

Güven³

et al. 2014

Anadolu Kardiyol Derg

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Objective: It has been documented that impaired heart rate variability (HRV) is related to life threatening arrhythmias in children with surgically repaired congenital heart disease. We aimed to analyze the balance of the cardiac autonomic functions by assessing HRV in children with arterial switch operation (ASO). Methods: In this observational cohort study, HRV analysis using 24-h Holter electrocardiography recordings was examined in 22 patients (mean age: 59.5±38.7 months, 18 male, 4 female) who had undergone ASO during the newborn period and 22 healthy children (mean age: 65.1±39.4 months, 18 male, 4 female). After Kolmogorov-Smirnov testing for normality, Student t-test and Mann-Whitney U test were used when appropriate. Chi-square was used for categorical data. Results: In 24-h HRV analysis showed that SDANN and VLF were significantly higher in patient group. Awake SDNN, rMSSD, pNN50, TP and VLF levels of patient group were significantly higher than those of control subjects. Awake LF/HF ratio in patient group was significantly higher than their counterpart in asleep group. In the patient group, awake rMSSD, pNN50, TP, LF and HF were significantly lower than their counterpart in the asleep group. Conclusion: Children with transposition of the great arteries (TGA) following ASO have not decreased levels of time and frequency HRV parameters in the mid-term follow-up period. All HRV parameters reflecting vagal tone were increased in the patient group. It is suggested that vagal tone is more predominant than sympathetic tone for children with ASO. (Anadolu Kardiyol Derg 2014; 14: 735-40)

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Contribution of the cervical sympathetic ganglia to the innervation of the pharyngeal arch arteries and the heart in the chick embryo

et al. 1999

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In the chick heart, sympathetic innervation is derived from the sympathetic neural crest (trunk neural crest arising from somite level 10-20). Since the trunk neural crest gives rise to sympathetic ganglia of their corresponding level, it suggests that the sympathetic neural crest develops into cervical ganglia 4-14. We therefore tested the hypothesis that, in addition to the first thoracic ganglia, the cervical ganglia might contribute to cardiac innervation as well. Putative sympathetic nerve connections between the cervical ganglia and the heart were demonstrated using the differentiation markers tyrosine hydroxylase and HNK-1. In addition, heterospecific transplantation (quail to chick) of the cardiac and trunk neural crest was used to study the relation between the sympathetic neural crest and the cervical ganglia. Quail cells were visualized using the quail nuclear antibody QCPN. The results by immunohistochemical study show that the superior and the middle cervical ganglia and possibly the carotid paraganglia contribute to the carotid nerve. This nerve subsequently joins the nodose ganglion of the vagal nerve via which it contributes to nerve fibers in cardiac vagal branches entering the arterial and venous pole of the heart. In addition, the carotid nerve contributes to nerve fibers connected to putative baro- and chemoreceptors in and near the wall of pharyngeal arch arteries suggesting a role of the superior and middle cervical ganglia and the paraganglia of the carotid plexus in sensory afferent innervation. The lower cervical ganglia 13 and 14 contribute predominantly to nerve branches entering the venous pole via the anterior cardinal veins. We did not observe a thoracic contribution. Heterospecific transplantation shows that the cervical ganglia 4-14 as well as the carotid paraganglia are derived from the sympathetic neural crest. The cardiac neural crest does not contribute to the neurons of the cervical ganglia. We conclude that the cervical ganglia contribute to cardiac innervation which explains the contribution of the sympathetic neural crest to the innervation of the chick heart.

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Sympathetic Denervation and Reinnervation After Arterial Switch Operation for Complete Transposition

Abstract: Cardiac sympathetic nerves were denervated early after and reinnervated late after ASO. Neonatal ASO may be favorable to facilitate sympathetic reinnervation, which may affect exercise tolerance late after surgery.

Cited by 61 publications

References 30 publications

Noninvasive Assessment of Autonomic Cardiovascular Function in Patients after Arterial Switch Operation for Transposition of the Great Arteries

Noninvasive Assessment of Autonomic Cardiovascular Function in Patients after Arterial Switch Operation for Transposition of the Great Arteries

Mid-term assessment of cardiac autonomic functions in children with transposition of the great arteries after arterial switch operation

Contribution of the cervical sympathetic ganglia to the innervation of the pharyngeal arch arteries and the heart in the chick embryo

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