Assessing subaortic right ventricle function after atrial switch repair through myocardial work analysis.

Area of Science:

• Cardiology
• Pediatric Cardiology
• Cardiac Surgery

Background:

• Mustard and Senning operations for D-TGA create a subaortic right ventricle (sRV).
• Prolonged QRS duration is a known negative prognostic factor in D-TGA patients.
• Current echocardiography has limitations in assessing sRV performance decline post-repair.

Purpose of the Study:

• To characterize Myocardial Work (MW) indices of the sRV in D-TGA patients following Mustard/Senning repair.
• To investigate the association between QRS duration and sRV function using MW indices.
• To explore the utility of MW analysis in detecting subclinical sRV dysfunction.

Main Methods:

• Retrospective analysis of adult D-TGA patients (2018-2022) post-Mustard/Senning repair.
• Collection of ECG parameters, echocardiographic images, and serum biomarkers.
• Offline calculation of MW indices and correlation with clinical variables; patients categorized by QRS duration (<120 ms vs. ≥120 ms).

Main Results:

• 51 D-TGA patients included; QRS duration correlated with sRV dimensions and NT-proBNP/troponin levels.
• No significant correlation found between QRS duration and intraventricular desynchrony or conventional echo parameters.
• QRS prolongation (≥120 ms) was associated with impaired septal MW, larger ventricles, and elevated biomarkers.

Conclusions:

• QRS prolongation post-Mustard/Senning repair indicates ventricular dilatation and compromised sRV performance, particularly affecting the septal wall.
• Global and regional MW analysis shows promise for assessing subclinical sRV function deterioration.
• MW indices offer a valuable tool for monitoring D-TGA patients after surgical repair.