Understanding the mechanism for branch pulmonary artery stenosis after the arterial switch operation for transposition of the great arteries

Morgan, Conall T.; Mertens, Luc; Grotenhuis, Heynric B.; Yoo, Shi Joon; Seed, Mike; Grosse-Wortmann, Lars

doi:10.1093/ehjci/jew046

Cited by 43 publications

(45 citation statements)

References 25 publications

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“…Due to the LPA and RPA embracing the aorta, the internal walls can present with a change in curvature even without any significant decrease of the lumen diameter (see for instance the LPA of Patient 2 and 3). Previous studies also conjectured that the onset of pulmonary stenosis is supposedly related to the stretched course of the pulmonary arteries in conjunction with the compression of the pulmonary branch due to the high-pressure aortic dilatation [10,11]. Typical features of stenotic flows were identified: flow acceleration, shear layer detachment and instability, and high values of wall shear stress both within the stenosis as well as on the opposite wall due to flow impingement [43,44].…”

Section: Discussionmentioning

confidence: 94%

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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Section: Discussionmentioning

confidence: 94%

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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“…Conventional measurements of the pulmonary arteries in the ASO patients, as shown in Table 2, are consistent with published literature. 8,25 The mean Nakata index was 154 + 82 mm 2 /m 2 . The pulmonary trunk tended to be rightward to the aorta, with a mean MPA angle of À13.2 + 20.4 from the median plane, and flatter along the sagittal plane than the axial plane (13.7 + 4.0 mm vs 19.1 + 5.2 mm, P < .0001).…”

Section: Conventional Cmr Measurementsmentioning

confidence: 96%

“…6 The causes of impaired RV performance can be related to perioperative factors (eg, reoxygenation injury) and postoperative complications, 7 with particular highlight on increased RV afterload from PA stenosis. 8 However, the RV can still demonstrate abnormal function, abnormal relaxation, and RV hypertrophy even in the presence of normal-sized pulmonary arteries. 6 Many previous studies have focused on PA stenosis after the Lecompte maneuver.…”

Section: Introductionmentioning

confidence: 99%

Abnormal Pulmonary Artery Bending Correlates With Increased Right Ventricular Afterload Following the Arterial Switch Operation

Loke

Capuano

Mandell

et al. 2019

World J Pediatr Congenit Heart Surg

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Purpose: In transposition of great arteries, increased right ventricular (RV) afterload is observed following arterial switch operation (ASO), which is not always related to pulmonary artery (PA) stenosis. We hypothesize that abnormal PA bending from the Lecompte maneuver may affect RV afterload in the absence of stenosis. Thus, we sought to identify novel measurements of three-dimensional cardiac magnetic resonance (CMR) images of the pulmonary arteries and compare with conventional measurements in their ability to predict RV afterload. Methods: Conventional measurements and novel measurements of the pulmonary arteries were performed using CMR data from 42 ASO patients and 13 age-matched controls. Novel measurements included bending angle, normalized radius of curvature ( Rc), and normalized weighted radius of curvature ( Rc- w). Right ventricular systolic pressures (as the surrogate for RV afterload) were measured by either recent echocardiogram or cardiac catheterization. Results: Conventional measurements of proximal PA size correlated with differential pulmonary blood flow ( r = 0.49, P = .001), but not with RV peak systolic pressures ( r = −0.26, P = .18). In ASO patients, Rc- w correlated with higher RV systolic pressures ( r = −0.57, P = .002). Larger neoaortic areas and rightward bending angles correlated with smaller right pulmonary artery Rc ( r = −0.48, P = .001; r = 0.41, P = .01, respectively). Finally, both pulmonary arteries had significantly smaller Rc compared to normal controls. Conclusions: Pulmonary arteries exhibit abnormal bends following ASO that correlate with increased RV afterload, independent of PA stenosis. Future work should focus on clinical and hemodynamic contributions of these shape parameters.

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“…Although bilateral PA stenosis increases the risk of reintervention compared with unilateral stenosis, the left PA was more commonly affected at the time of reintervention. Potential explanations for this finding include site of prior duct ligation, compression by the neoaorta in patients after the arterial switch operation, and kinking from redundant RV outflow tract (or conduit) tissue [10,11].…”

Section: Commentmentioning

confidence: 99%

Long-Term Outcomes After Surgical Pulmonary Arterioplasty and Risk Factors for Reintervention

Cresalia

Armstrong

Romano

et al. 2018

The Annals of Thoracic Surgery

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Understanding the mechanism for branch pulmonary artery stenosis after the arterial switch operation for transposition of the great arteries

Abstract: Neo-pulmonary to neo-aortic geometry as well as post-operative compression of the LPA by an enlarged aorta impact LPA size and perfusion of the left lung.

Cited by 43 publications

References 25 publications

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

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

Abnormal Pulmonary Artery Bending Correlates With Increased Right Ventricular Afterload Following the Arterial Switch Operation

Long-Term Outcomes After Surgical Pulmonary Arterioplasty and Risk Factors for Reintervention

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