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Ventricular development and function in complete transposition: angiocardiographic evaluation.

L Daliento, G Cuman, G Isabella

    International Journal of Cardiology
    |September 1, 1986
    PubMed
    Summary
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    In complete transposition of the great arteries, the left ventricle shows inadequate mass and decreased contractility in the first year of life, despite normal initial development. The right ventricle volume increases, but ejection fraction declines.

    Area of Science:

    • Pediatric Cardiology
    • Congenital Heart Disease
    • Cardiac Development

    Background:

    • Complete transposition of the great arteries (TGA) presents unique challenges in ventricular development and function.
    • Early assessment of ventricular adaptation is crucial for managing TGA patients.

    Purpose of the Study:

    • To evaluate the developmental trajectory and functional status of both ventricles in infants with TGA.
    • To analyze how associated cardiac lesions and age influence ventricular performance.

    Main Methods:

    • Retrospective analysis of 50 left and 41 right ventricular cineangiograms from 40 infants with TGA (situs solitus).
    • Patients categorized by ventricular septal integrity, presence of pulmonary stenosis, and age (<60 days vs. >60 days).
    • Assessment of ventricular volumes, ejection fraction, systolic pressure, end-systolic volume, left ventricular mass, and stress.

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    Main Results:

    • Left ventricle (LV) volume overload is evident from birth; LV mass fails to keep pace with volume increase, becoming inadequate by one year.
    • In TGA with an intact ventricular septum, LV contractility decreases during the first year, despite adequate oxygen saturation.
    • Right ventricle (RV) volume increases post-atrial septostomy, but ejection fraction progressively declines, linked to reduced contractility.

    Conclusions:

    • Infants with TGA experience progressive LV inadequacy and functional decline within the first year of life, even with an intact septum.
    • Associated anomalies and hemodynamic pressures significantly impact LV mass and function.
    • RV function deteriorates over time, necessitating careful monitoring and management strategies.