Influence of the two-stage anatomic correction of simple transposition of the great arteries on left ventricular...

To evaluate the influence of the 2-stage anatomic correction of simple transposition of the great arteries on left ventricular (LV) function, pressure and angiocardiographic volume data were analyzed during resting conditions shortly before banding of the pulmonary trunk (n = 12) and before (n = 17) and after anatomic correction (n = 11), and compared with data from controls (n = 12). Age at banding and anatomic correction was between 1 and 44 months (mean 16 +/- 10) and between 13 and 47 months (mean 24 +/- 10), respectively. The interval between anatomic correction and the investigation ranged from 10 to 29 months (mean 20 +/- 7). After banding, LV ejection fraction decreased (p less than 0.01) and LV peak systolic pressure (p less than 0.01) as well as LV end-diastolic pressure (p less than 0.05) increased. After anatomic correction, these variables and LV end-systolic wall stress were not significantly different from control values. The LV end-systolic wall stress-ejection fraction relation in 7 of 11 patients after anatomic correction was within control range. The highest values were found in the youngest patients at banding and at anatomic correction. In contrast to measures of global myocardial function, such as LV ejection fraction and LV end-diastolic pressure data, the LV end-systolic stress-ejection fraction relation suggest that LV function may not be normal in some patients 20 months after anatomic correction. Young age at operation, however, appears to be advantageous in preserving LV function. Hemodynamic alterations after banding probably reflect LV adaptation to systemic pressures in a hypoxemic circulation.