HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Aldo R. Castañeda Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Colan, S. D. Articles by Wernovsky, G. Search for Related Content PubMed PubMed Citation Articles by Colan, S. D. Articles by Wernovsky, G.

J Thorac Cardiovasc Surg 1995;109:311-321
© 1995 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

Status of the left ventricle after arterial switch operation for transposition of the great arteriesHemodynamic and echocardiographic evaluation

Boston, Mass.

From the Departments of Pediatrics and Surgery, Harvard Medical School, and the Departments of Cardiology and Cardiovascular Surgery, Children's Hospital, Boston, Mass.

Received for publication July 27, 1994. Accepted for publication Nov. 7, 1994. Address for reprints: Steven D. Colan, MD, Department of Cardiology, Children's Hospital, 300 Longwood Ave., Boston, MA 02115.

Abstract

Background: The potential for improved preservation of systemic ventricular function represents an important reason for the increasing popularity of the arterial switch operation. In support of this expectation, prior studies in patients early after arterial switch operation have found normal ventricular contractility and function. This study was conducted to extend those observations to up to 10 years of follow-up and to directly examine the effects of a coexisting ventricular septal defect or short-term preparatory banding of the pulmonary artery before the arterial switch operation.
Methods: Patients operated on from 1983 through 1991 were included. Echocardiographic and catheterization data were collected as part of a prospective evaluation of outcome in all patients who undergo the arterial switch operation at Boston Children's Hospital, with inclusion of data from the most recent catheterization only. Echocardiograms performed at least 6 months after the operation were included, with assessment of both the most recent status as well as serial trends. Whenever possible, echocardiographic evaluation included data necessary to perform analysis of ventricular mechanics including indices of afterload, preload, and contractility. Comparison was made to normal values and between subgroups defined on the basis of an arterial switch operation with or without ventricular septal defect and those who had a rapid two-stage arterial switch operation.
Results: Invasive measures of left and right ventricular filling pressures, cardiac index, and pulmonary vascular resistance did not differ among the three groups. Overall, echocardiographic left ventricular end-diastolic dimension, wall thickness, mass, afterload (end-systolic wall stress), function (fractional shortening and rate-corrected velocity of fiber shortening), contractility (stress-velocity and stress-shortening relations), and preload were normal, and none of these variables was different between the groups with and without a ventricular septal defect. Serial evaluation indicated a slight but significant trend toward ventricular dilatation, perhaps related to a relatively high incidence of at least mild aortic regurgitation (30%). In contrast, in the rapid two-stage group the echocardiographic indices of left ventricular function (fractional shortening and velocity of fiber shortening) and contractility (stress-velocity and stress-shortening relations) were found to be mildly but significantly reduced compared with normal subjects and with the other arterial switch operation groups. Over the duration of follow-up encompased by this study, no tendency toward progressive depression of function was seen.
Conclusions: As the length of observation after the arterial switch operation continues to increase, left ventricular size, mass, functional status, and contractility continues to be normal, with no evidence of time-related deterioration of function. As previously reported, the rapid two-stage arterial switch operation does represent a higher risk for mild impairment of myocardial mechanics. (J THORAC CARDIOVASC SURG 1995;109:311-21)

This article has been cited by other articles:

				S. K. Pasquali, B. S. Marino, M. G. McBride, G. Wernovsky, and S. M. Paridon Coronary artery pattern and age impact exercise performance late after the arterial switch operation. J. Thorac. Cardiovasc. Surg., November 1, 2007; 134(5): 1207 - 1212. [Abstract] [Full Text] [PDF]

				K. Sivakumar, E. Francis, P. Krishnan, and J. Shahani Ductal stenting retrains the left ventricle in transposition of great arteries with intact ventricular septum. J. Thorac. Cardiovasc. Surg., November 1, 2006; 132(5): 1081 - 1086. [Abstract] [Full Text] [PDF]

				S. G Raja, A. Shauq, and M. Kaarne Outcomes after Arterial Switch Operation for Simple Transposition Asian Cardiovasc Thorac Ann, June 1, 2005; 13(2): 190 - 198. [Abstract] [Full Text] [PDF]

				L Hui, A K T Chau, M P Leung, C S W Chiu, and Y F Cheung Assessment of left ventricular function long term after arterial switch operation for transposition of the great arteries by dobutamine stress echocardiography Heart, January 1, 2005; 91(1): 68 - 72. [Abstract] [Full Text] [PDF]

				N. Kang, M. R. de Leval, M. Elliott, V. Tsang, E. Kocyildirim, I. Sehic, J. Foran, and I. Sullivan Extending the Boundaries of the Primary Arterial Switch Operation in Patients With Transposition of the Great Arteries and Intact Ventricular Septum Circulation, September 14, 2004; 110(11_suppl_1): II-123 - II-127. [Abstract] [Full Text] [PDF]

				H.-H. Kramer, J. Scheewe, G. Fischer, A. Uebing, P. Harding, F. Schmiel, and J. Cremer Long term follow-up of left ventricular performance and size of the great arteries before and after one- and two-stage arterial switch operation of simple transposition Eur. J. Cardiothorac. Surg., December 1, 2003; 24(6): 898 - 905. [Abstract] [Full Text] [PDF]

				W. G. Williams, B. W. McCrindle, D. A. Ashburn, R. A. Jonas, C. Mavroudis, E. H. Blackstone, and the members of the Congenital Heart Surgeon's Soci Outcomes of 829 neonates with complete transposition of the great arteries 12-17 years after repair Eur. J. Cardiothorac. Surg., July 1, 2003; 24(1): 1 - 10. [Abstract] [Full Text] [PDF]

				H. H. Hovels-Gurich, M.-C. Seghaye, Q. Ma, M. Miskova, R. Minkenberg, B. J. Messmer, and G. von Bernuth Long-term results of cardiac and general health status in children after neonatal arterial switch operation Ann. Thorac. Surg., March 1, 2003; 75(3): 935 - 943. [Abstract] [Full Text] [PDF]

				S. K. Pasquali, V. Hasselblad, J. S. Li, D. F. Kong, and S. P. Sanders Coronary Artery Pattern and Outcome of Arterial Switch Operation for Transposition of the Great Arteries: A Meta-Analysis Circulation, November 12, 2002; 106(20): 2575 - 2580. [Abstract] [Full Text] [PDF]

				M. V. T. Tantengco, R. L. Thomas, and P. P. Karpawich Left ventricular dysfunction after long-term right ventricular apical pacing in the young J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2093 - 2100. [Abstract] [Full Text] [PDF]

				S. H. Daebritz, A. R. Tiete, J. S. Sachweh, W. Engelhardt, G. von Bernuth, and B. J. Messmer Systemic right ventricular failure after atrial switch operation: midterm results of conversion into an arterial switch Ann. Thorac. Surg., April 1, 2001; 71(4): 1255 - 1259. [Abstract] [Full Text] [PDF]

				N. J. Wilson, P. M. Clarkson, B. G. Barratt-Boyes, A. L. Calder, R. M. L. Whitlock, R. N. Easthope, and J. M. Neutze Long-term outcome after the mustard repair for simple transposition of the great arteries: 28-year follow-up J. Am. Coll. Cardiol., September 1, 1998; 32(3): 758 - 765. [Abstract] [Full Text] [PDF]

				K. Yatsunami, M. Nakazawa, C. Kondo, H. Teshima, K. Momma, Y. Takanashi, and Y. Imai Small Left Coronary Arteries After Arterial Switch Operation for Complete Transposition Ann. Thorac. Surg., September 1, 1997; 64(3): 746 - 750. [Abstract] [Full Text]

				J. L. Myers Transposition of the Great Arteries Ann. Thorac. Surg., March 1, 1997; 63(3): 895 - 898. [Full Text]

				G. Wernovsky, D. Wypij, R. A. Jonas, J. E. Mayer Jr, F. L. Hanley, P. R. Hickey, A. Z. Walsh, A. C. Chang, A. R. Castaneda, J. W. Newburger, et al. Postoperative Course and Hemodynamic Profile After the Arterial Switch Operation in Neonates and Infants : A Comparison of Low-Flow Cardiopulmonary Bypass and Circulatory Arrest Circulation, October 15, 1995; 92(8): 2226 - 2235. [Abstract] [Full Text]