Left ventricle function after arterial switch procedure for D-transposition of the great arteries: Long term
Giulia Bragantini1, Ylenia Bartolacelli1, Anna Balducci1
1Department of Pediatric Cardiology and Adult Congenital Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Insights
Patients who underwent arterial switch procedure (ASO) for transposition of great arteries (TGA) show normal ejection fraction but reduced longitudinal strain. Speckle-tracking echocardiography (STE) can detect this subclinical myocardial dysfunction early.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Echocardiography
Background:
- Transposition of Great Arteries (TGA) is a critical congenital heart defect.
- The Arterial Switch Procedure (ASO) is a common surgical repair for TGA.
- Long-term assessment of left ventricle (LV) function after ASO is crucial for patient management.
Purpose of the Study:
- To evaluate long-term left ventricle (LV) function in asymptomatic patients after Arterial Switch Procedure (ASO) for Transposition of Great Arteries (TGA).
- To assess myocardial deformation using speckle-tracking echocardiography (STE) in this patient cohort.
- To identify potential factors associated with subclinical LV dysfunction.
Main Methods:
- Study included 59 asymptomatic patients (mean age 13.9 years) post-ASO for TGA with normal LV ejection fraction.
- Speckle-tracking echocardiography (STE) was employed to evaluate LV volume, function, and myocardial deformation.
- Comparison was made with healthy age-matched peers.
Main Results:
- Patients demonstrated normal LV ejection fraction but significantly lower Global Longitudinal Strain (GLS) compared to healthy controls across various age groups.
- Univariate analysis linked GLS to restrictive patent foramen ovale at birth.
- Multivariate analysis identified prenatal diagnosis, restrictive patent foramen ovale, and bypass time as significant factors related to GLS.
Conclusions:
- Late after ASO for TGA, patients exhibit normal ejection fraction but subclinical myocardial dysfunction, evidenced by reduced longitudinal strain.
- Speckle-tracking echocardiography (STE) is a valuable tool for early detection of this myocardial dysfunction.
- These findings highlight the importance of continued monitoring in patients post-ASO.
Aim:
The objective of this study was to assess left ventricle (LV) function in patients underwent arterial switch procedure (ASO) for transposition of great arteries (TGA) in long-term follow-up.
Methods:
We studied 59 asymptomatic patients (43 male) who have undergone single-stage ASO for TGA, aged 13.9 ± 4.8 years, with a normal LV ejection fraction, compared to healthy peers. We evaluated LV volume, function and myocardial deformation in asymptomatic patients with normal ejection fraction by using speckle-tracking echocardiography (STE).
Results:
Global longitudinal strain (GLS) was lower in patients compared to healthy peers throughout all age groups (5-9 years: -20.03 ± 0.65% vs 21.00 ± 1.30%, p = 0.083; 10-14 years: -19.43 ± 1.75% vs -21.80 ± 1.30%, p < 0.0001; 15-19 years: -19.05 ± 1.65% vs -22.50 ± 1.30%, p < 0.0001; 20-24 years: -17.90 ± 0.85% vs -20.90 ± 1.30%, p < 0.0001; >25 years: -18.60 ± 0.42% vs 20.60 ± 1.20%, p = 0.041). At the univariate analysis GLS resulted significantly related only to the presence of restrictive patent foramen ovale at birth (p = 0.0016). At the multivariate analysis GLS was significantly related to prenatal diagnosis, restrictive patent foramen ovale and by-pass time.
Conclusion:
Children and young adults late after ASO demonstrate normal ejection fraction, but present subclinical signs of myocardial dysfunction, such as reduction of longitudinal strain. Our findings support the usefulness of STE to detect it precociously.
