Giovanni Biglino1, Hopewell Ntsinjana2, Carla Plymen3, Oliver Tann3, Alessandro Giardini3, Graham Derrick3, Kim H Parker4, Victor Tsang3, Silvia Schievano2, Andrew M Taylor2. 1. Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, United Kingdom; Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom. Electronic address: g.biglino@ucl.ac.uk. 2. Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, United Kingdom; Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom. 3. Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom. 4. Department of Bioengineering, Imperial College, London, United Kingdom.
Abstract
OBJECTIVE: The aim of this study was to compare atrial switch and arterial switch operations for the repair of transposition of the great arteries (TGA), assessing cardiac function and ventriculoarterial (VA) coupling based on cardiac magnetic resonance (CMR) data. Using CMR-derived wave intensity analysis, this study provides a noninvasive comparison of the 2 systemic ventricles and evaluates the subclinical hemodynamic burden of these operations. METHODS: Fifty-four patients (18 controls, 18 atrial switches, 18 arterial switches) were studied. Dimensional and functional data, including the ejection fraction (EF) and end-diastolic volume, were derived from CMR, as well as aortic distensibility. Wave intensity was computed from CMR according to a formulation based on changes in area and velocity, and the peaks of the 2 major systolic waves (forward compression wave [FCW], and forward expansion wave [FEW]) were measured as indicators of ventricular function. RESULTS: Both switches exhibited significantly increased end-diastolic volume and enlarged aortic root areas, and atrial switches were also characterized by significantly lower EF. Patients with TGA presented stiffer ascending aortas, particularly those repaired with an arterial switch. Both FCW and FEW were significantly lower in both TGA cohorts than the controls, suggesting compromised VA coupling, likely a result of increased impedance caused by the stiffer ascending aorta. A significant difference between switch type was noticed in terms of the FEW peak, which was lower in the atrial switch group. CONCLUSIONS: These data highlight reduced aortic distensibility and abnormal VA coupling in repaired TGA. An intraoperational difference was noted in terms of EF and peak FEW, likely reflecting the different nature of the subaortic ventricle.
OBJECTIVE: The aim of this study was to compare atrial switch and arterial switch operations for the repair of transposition of the great arteries (TGA), assessing cardiac function and ventriculoarterial (VA) coupling based on cardiac magnetic resonance (CMR) data. Using CMR-derived wave intensity analysis, this study provides a noninvasive comparison of the 2 systemic ventricles and evaluates the subclinical hemodynamic burden of these operations. METHODS: Fifty-four patients (18 controls, 18 atrial switches, 18 arterial switches) were studied. Dimensional and functional data, including the ejection fraction (EF) and end-diastolic volume, were derived from CMR, as well as aortic distensibility. Wave intensity was computed from CMR according to a formulation based on changes in area and velocity, and the peaks of the 2 major systolic waves (forward compression wave [FCW], and forward expansion wave [FEW]) were measured as indicators of ventricular function. RESULTS: Both switches exhibited significantly increased end-diastolic volume and enlarged aortic root areas, and atrial switches were also characterized by significantly lower EF. Patients with TGA presented stiffer ascending aortas, particularly those repaired with an arterial switch. Both FCW and FEW were significantly lower in both TGA cohorts than the controls, suggesting compromised VA coupling, likely a result of increased impedance caused by the stiffer ascending aorta. A significant difference between switch type was noticed in terms of the FEW peak, which was lower in the atrial switch group. CONCLUSIONS: These data highlight reduced aortic distensibility and abnormal VA coupling in repaired TGA. An intraoperational difference was noted in terms of EF and peak FEW, likely reflecting the different nature of the subaortic ventricle.
Authors: Heather Y Sun; Katie Jo Stauffer; Susan E Nourse; Chau Vu; Elif Seda Selamet Tierney Journal: Pediatr Cardiol Date: 2017-03-27 Impact factor: 1.655
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Authors: Claire E Raphael; Jennifer Keegan; Kim H Parker; Robin Simpson; Julian Collinson; Vass Vassiliou; Ricardo Wage; Peter Drivas; Stephen Strain; Robert Cooper; Ranil de Silva; Rod H Stables; Carlo Di Mario; Michael Frenneaux; Dudley J Pennell; Justin E Davies; Alun D Hughes; David Firmin; Sanjay K Prasad Journal: J Cardiovasc Magn Reson Date: 2016-12-09 Impact factor: 5.364