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A Comprehensive Functional Analysis in Patients after Atrial Switch Surgery.

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Assessing right ventricular (RV) function after atrial switch surgery is challenging. This study found reduced RV strain and significant diastolic dyssynchrony using invasive and cardiac magnetic resonance imaging (CMR) methods.

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Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Imaging

Background:

  • Long-term outcomes after atrial switch operation are influenced by progressive right ventricular (RV) dysfunction.
  • Evaluating subtle functional changes in the systemic RV requires advanced assessment techniques.

Purpose of the Study:

  • To investigate subtle functional parameters of the systemic RV using invasive conductance technique and noninvasive cardiac magnetic resonance imaging (CMR).
  • To assess RV function and identify potential indicators of deterioration in patients post-atrial switch surgery.

Main Methods:

  • Invasive pressure-volume loops (baseline and dobutamine) and noninvasive CMR with feature tracking (FT) were used to evaluate RV function.
  • Cardiopulmonary exercise testing (CPET) was performed on all 16 patients (aged 28.2 ± 7.3 years) who underwent atrial switch surgery (Senning or Mustard).

Main Results:

  • CMR-FT showed reduced global systolic strain in the systemic RV compared to the subpulmonary left ventricle.
  • Invasive measurements revealed reduced end-systolic elastance (Ees) with a significant increase under dobutamine, but no significant change in end-diastolic elastance (Eed).
  • Conductance analysis identified significant intraventricular mechanical dyssynchrony, predominantly during diastole, with no clear correlation between load-independent indices, strain, or CPET parameters.

Conclusions:

  • Functional assessment of the deteriorating systemic RV remains complex.
  • Reduced RV strain and significant diastolic dyssynchrony were observed, highlighting the challenges in assessing RV function post-atrial switch.
  • The study underscores the presence of intraventricular dyssynchrony, particularly diastolic, in patients after atrial switch surgery.