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Long-term ventricular performance after intra-atrial correction of transposition: left ventricular filling is the
1Kardiocentrum, University Hospital Motol, Prague, Czech Republic. oleg.reich@lfmotol.cuni.cz
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This study found that while systolic dysfunction after Mustard or Senning operations remains stable, diastolic dysfunction affects up to 80% of patients, with left ventricular peak filling rate worsening over time.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Cardiovascular Physiology
Background:
- Mustard and Senning operations are palliative procedures for complex congenital heart defects.
- Long-term ventricular function after these surgeries is not fully understood.
- Assessing systolic and diastolic dysfunction is crucial for patient management.
Purpose of the Study:
- To determine the incidence of right and left ventricular systolic and diastolic dysfunction after Mustard or Senning operations.
- To evaluate changes in dysfunction incidence during long-term follow-up.
Main Methods:
- A postoperative case-control study utilizing radionuclide ventriculography.
- Evaluated ejection fractions, peak filling rates, and filling periods/fractions.
- Included 153 patients at a median age of 6.9 years, with a subset re-evaluated at a median age of 15.3 years.
Main Results:
- Systolic dysfunction incidence was 8% (RV) and 10% (LV) at 13 years post-surgery, showing no significant increase over 8 years.
- Diastolic dysfunction was prevalent, affecting up to 80% of patients.
- Left ventricular peak filling rate significantly deteriorated over time (p < 0.05).
Conclusions:
- Systolic ventricular dysfunction is relatively stable long-term after Mustard/Senning procedures.
- Diastolic dysfunction is common and may worsen with time, particularly left ventricular peak filling rate.
- Regular monitoring of diastolic function is recommended for these patients.
Objective:
To establish the incidence of systolic and diastolic dysfunction of the right and left ventricle in a large cohort of patients after Mustard or Senning operations and to assess changes in the incidence on long term follow up.
Design:
Postoperative case-control study using radionuclide ventriculography. Ejection fractions, peak filling rates, rapid filling periods and fractions, slow filling periods and fractions, and atrial contraction periods and fractions were studied.
Setting:
Tertiary care centre, ambulatory and hospital inpatient care.
Patients:
A convenience sample of 153 patients studied at median age of 6.9 years (median 4.4 years after surgery). In 99 cases another study was available at a median age of 15.3 years (median 13 years after surgery and 8.8 years after the first study).
Results:
Respective incidences of dysfunction in the first and the second study were as follows: ejection fraction-right ventricle 7.8% and 8.1%, left ventricle 7.2% and 10.1%: peak filling rate-right ventricle 0% and 4.2%, left ventricle 14.3% and 29.5% (p < 0.05); rapid filling period-right ventricle 18.3% and 11.6%, left ventricle 30.2% and 30.5%; slow filling period-right ventricle 4.8% and 3.2%; left ventricle 11.9% and 23.2%; atrial contraction period-right ventricle 0.8% and 4.2%, left ventricle 15.1% and 26.3%; rapid filling fraction-right ventricle both 0%, left ventricle 82.5% and 79.0%; slow filling fraction-right ventricle 0.8% and 4.2%, left ventricle 37.3% and 30.5%; atrial contraction fraction-right ventricle both 0%, left ventricle 79.4% and 71.6%.
Conclusions:
The incidence of systolic ventricular dysfunction is 8% (right ventricle) and 10% (left ventricle) 13 years after surgery, without a significant increase over the eight year follow up. Diastolic filling is abnormal in up to 80% of patients and left ventricular peak filling rate deteriorates with time.