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Two decades after the arterial switch operation: stable right ventricular function but reduced exercise capacity.

Renée S Joosen1, Marielle C van de Veerdonk2, Anneloes E Bohte3

  • 1Department of Pediatric Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.

Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance
|April 26, 2025
PubMed
Summary

Long-term follow-up after arterial switch operation for transposition of the great arteries shows stable right ventricular function but declining exercise capacity. This highlights the need for continued monitoring of exercise performance in these patients.

Keywords:
Arterial switch operationCardiac magnetic resonance imagingExercise capacityTransposition of the great arteriesVentricular function

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Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • Right ventricular (RV) function and exercise capacity are crucial prognostic indicators in patients with transposition of the great arteries (TGA) following arterial switch operation (ASO).
  • Longitudinal assessment of RV dimensions, global function, and exercise capacity is essential for understanding long-term outcomes after ASO.
  • Comparing outcomes between TGA patients with and without RV pressure overload provides insights into specific risk factors.

Purpose of the Study:

  • To longitudinally evaluate right ventricular (RV) dimensions, global function, and exercise capacity in patients with transposition of the great arteries (TGA) after arterial switch operation (ASO).
  • To compare the changes in RV parameters and exercise capacity over time between TGA patients with and without RV pressure overload.
  • To assess the stability of RV dimensions, function, strain, and aortic root dimensions during long-term follow-up post-ASO.

Main Methods:

  • Retrospective analysis of TGA patients post-ASO with two cardiovascular magnetic resonance (CMR) examinations between 2004 and March 2024.
  • Measurement of cardiac volumes, function, strain, and vessel dimensions using CMR.
  • Categorization of patients based on RV pressure overload and comparison of repeated exercise tests in a subset.

Main Results:

  • RV volumes, function, and strain remained stable during long-term follow-up (median 21 years post-ASO).
  • Aortic root dimensions showed no significant progression during long-term follow-up.
  • Exercise capacity (VO2peak) declined in a significant portion of patients (46% at long-term follow-up), unrelated to peak heart rate or chronotropic index. No differences were observed between patients with and without RV pressure overload.

Conclusions:

  • Long-term exercise capacity is impaired in a substantial number of TGA patients post-ASO.
  • Right ventricular dimensions, global function, strain, and aortic root dimensions are stable during long-term follow-up after ASO.
  • The decline in exercise capacity is a key concern, necessitating continued monitoring and management strategies.