Vivan J M Baggen1, Mieke M P Driessen2, Folkert J Meijboom3, Gertjan Tj Sieswerda3, Nicolaas J G Jansen4, Sebastiaan W H van Wijk3, Pieter A Doevendans3, Tim Leiner5, Paul H Schoof6, Tim Takken7, Johannes M P J Breur8. 1. Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands; Department of Cardiology, UMC Utrecht, Utrecht, The Netherlands. 2. Department of Cardiology, UMC Utrecht, Utrecht, The Netherlands; ICIN-Netherlands Heart Institute, Utrecht, The Netherlands. 3. Department of Cardiology, UMC Utrecht, Utrecht, The Netherlands. 4. Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands. 5. Department of Radiology, UMC Utrecht, Utrecht, The Netherlands. 6. Department of Pediatric Cardiothoracic Surgery, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands. 7. Department of Pediatric Physical Therapy and Exercise Physiology, Child Development and Exercise Center, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands. 8. Department of Pediatric Cardiology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands. Electronic address: h.breur@umcutrecht.nl.
Abstract
OBJECTIVES: Despite excellent survival in patients after the arterial switch operation, reintervention is frequently required and exercise capacity is decreased in a substantial number of patients. This study relates right-sided imaging features in patients long-term after the arterial switch operation to exercise capacity and ventilatory efficiency to investigate which lesions are functionally important. METHODS: Patients operated in the UMC Utrecht, the Netherlands (1976-2001) and healthy controls underwent cardiac magnetic resonance imaging and cardiopulmonary exercise testing within 1 week. We measured main, left, and right pulmonary artery cross-sectional areas, pulmonary blood flow distribution, peak oxygen uptake, and minute ventilation relative to carbon dioxide elimination. RESULTS: A total of 71 patients (median age, 20 [12-35] years, 73% were male) and 21 healthy controls (median age, 26 [21-35] years, 48% were male) were included. Main, left, and right pulmonary artery areas were decreased compared with controls (190 vs 269 mm(2)/m(2), 59 vs 157 mm(2)/m(2), 98 vs 139 mm(2)/m(2), respectively, all P < .001); however, pulmonary blood flow distribution was comparable (P = .722). Peak oxygen uptake and minute ventilation relative to carbon dioxide elimination were 88% ± 20% and 23.7 ± 3.8, respectively, with 42% and 1% of patients demonstrating abnormal results (≤ 84% and ≥ 34, respectively). The main pulmonary artery area significantly correlated with peak oxygen uptake (r = 0.401, P = .001) and pulmonary blood flow distribution with minute ventilation relative to carbon dioxide elimination (r = -0.329, P = .008). Subanalysis (<18, 18-25, >25 years) showed that the main pulmonary artery area was smaller in older age groups. In multivariable analysis, the main pulmonary artery area was independently associated with peak oxygen uptake (P = .032). CONCLUSIONS: In adult patients after the arterial switch operation, narrowing of the main pulmonary artery is a common finding and is the main determinant of limitation in functional capacity, rather than pulmonary branch stenosis.
OBJECTIVES: Despite excellent survival in patients after the arterial switch operation, reintervention is frequently required and exercise capacity is decreased in a substantial number of patients. This study relates right-sided imaging features in patients long-term after the arterial switch operation to exercise capacity and ventilatory efficiency to investigate which lesions are functionally important. METHODS:Patients operated in the UMC Utrecht, the Netherlands (1976-2001) and healthy controls underwent cardiac magnetic resonance imaging and cardiopulmonary exercise testing within 1 week. We measured main, left, and right pulmonary artery cross-sectional areas, pulmonary blood flow distribution, peak oxygen uptake, and minute ventilation relative to carbon dioxide elimination. RESULTS: A total of 71 patients (median age, 20 [12-35] years, 73% were male) and 21 healthy controls (median age, 26 [21-35] years, 48% were male) were included. Main, left, and right pulmonary artery areas were decreased compared with controls (190 vs 269 mm(2)/m(2), 59 vs 157 mm(2)/m(2), 98 vs 139 mm(2)/m(2), respectively, all P < .001); however, pulmonary blood flow distribution was comparable (P = .722). Peak oxygen uptake and minute ventilation relative to carbon dioxide elimination were 88% ± 20% and 23.7 ± 3.8, respectively, with 42% and 1% of patients demonstrating abnormal results (≤ 84% and ≥ 34, respectively). The main pulmonary artery area significantly correlated with peak oxygen uptake (r = 0.401, P = .001) and pulmonary blood flow distribution with minute ventilation relative to carbon dioxide elimination (r = -0.329, P = .008). Subanalysis (<18, 18-25, >25 years) showed that the main pulmonary artery area was smaller in older age groups. In multivariable analysis, the main pulmonary artery area was independently associated with peak oxygen uptake (P = .032). CONCLUSIONS: In adult patients after the arterial switch operation, narrowing of the main pulmonary artery is a common finding and is the main determinant of limitation in functional capacity, rather than pulmonary branch stenosis.
Authors: Covadonga Terol Espinosa de Los Monteros; Roel L F Van der Palen; Mark G Hazekamp; Lukas Rammeloo; Monique R M Jongbloed; Nico A Blom; Arend D J Ten Harkel Journal: Pediatr Cardiol Date: 2021-02-01 Impact factor: 1.655