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Functional and morphometric changes in children after neonatal arterial switch operation for transposition of the
Carin Cristina Walter1,2, Maria Clara Escobar-Diaz1,2, Sergi Cesar1,2
1Department of Pediatric Cardiology, Sant Joan de Déu Hospital, Barcelona, Spain.
Insights
Children with D-Transposition of the great arteries (TGA) after arterial switch operation (ASO) show altered right ventricle shape and function. These echocardiographic changes highlight the need for long-term outcome studies in TGA survivors.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Echocardiography
Background:
- Increased survival rates in D-Transposition of the great arteries (TGA) necessitate evaluation of long-term outcomes post-arterial switch operation (ASO).
- Conventional echocardiography is common, but detailed cardiac function and morphometric analysis in pediatric TGA survivors is limited.
Purpose of the Study:
- To describe functional and morphometric echocardiographic changes in children following ASO for TGA.
- To identify specific echocardiographic alterations in the cardiac structure and function of TGA patients post-ASO.
Main Methods:
- Observational study including 21 children (1-5 years) who underwent neonatal ASO for TGA.
- Comparison of morphometric and functional echocardiographic parameters with 52 age-matched healthy controls.
Main Results:
- Patients exhibited significant morphological and functional changes, particularly in the right ventricle (RV).
- The RV showed a more globular shape (basal sphericity index 1.5 vs. 1.8, P=0.016) and decreased systolic function (FAC 51% vs. 58%, P=0.006).
- Reduced tricuspid annular plane systolic excursion (13 vs. 20 mm, P=0.001) and longitudinal myocardial deformation (apical septum -23% vs. -27%, P=0.005) were observed.
Conclusions:
- Children with TGA after ASO present with distinct echocardiographic morphometric and functional changes, notably in the RV.
- These include alterations in RV shape (globular) and reduced systolic function.
- Further prospective studies are needed to determine the long-term impact of these echocardiographic findings on patient outcomes.
Background:
The increase in the survival of patients with D-Transposition of the great arteries (TGA) after arterial switch operation (ASO) has now turned our focus to the evaluation of mid and long-term outcomes. Although most patients are followed by conventional echocardiography, the study of cardiac functionality and morphometric parameters in children with TGA after ASO is scarce. The present study aims to describe the functional and morphometric echocardiographic changes in children after ASO.
Methods:
We performed an observational study in patients aged 1-5 years with TGA who underwent neonatal ASO. Morphometric and functional echocardiographic parameters were analyzed in 21 patients and compared with 52 age-matched healthy controls.
Results:
We found morphological and functional changes, especially in the right ventricle, which is more globular (right ventricle [RV] basal sphericity index 1.5 vs. 1.8, P = 0.016), and with a decreased systolic function compared to healthy controls (fractional area change 51 vs. 58%, P = 0.006; tricuspid annular plane systolic excursion 13 vs. 20 mm, P = 0.001; s' 7 vs. 12 cm/s, P = 0.001). In the speckle-tracking strain imaging, there was a decrease in the longitudinal deformation of the apical septal myocardium (-23% vs. -27%; P = 0.005). Preoperative systemic overload to the right ventricle could be an important factor in the origin of these changes.
Conclusions:
In patients with TGA after ASO, there are morphometric and functional echocardiographic changes, such as globular form and decreased function, especially in the RV; the effect of these changes on long-term outcomes would require prospective follow-up studies.
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