An evaluation of right and left ventricular function after anatomical correction and intra-atrial repair operations for complete transposition of the great arteries.

Abstract

Anatomical correction of complete transposition of the great arteries has the potential advantage over intra-atrial repair in that the left ventricle becomes the systemic pump. To investigate the importance of this, we evaluated right and left ventricular function in 21 patients after anatomical correction and in 21 patients after Mustard or Senning operations. First-pass and equilibrium-gated radionuclide angiography were used to measure right and left ventricular ejection fractions between 17 and 78 (mean, 47) months after anatomical correction and between 3 and 187 (mean, 67) months after intra-atrial repair. The mean age of the patient groups at the time of study was 52 and 84 months, respectively. The right ventricular ejection fraction ranged from 35% to 78% (mean, 58%) in patients after anatomical correction and from 27% to 68% (mean, 51%) after intra-atrial repair (p=0.066). The left ventricular ejection fraction ranged from 39%1 to 74% (mean, 58%) after anatomical correction and from 35% to 74% (mean, 58%) after intra-atrial repair (p=0.86). The mean right and left ventricular ejection fractions of both groups were significantly lower than those of normal children. Individuals with systemic ventricular dysfunction were identified after both types of operations; however, symptomatic dysfunction occurred only after intra-atrial repair (p =0.24). (Circulation 1990;82:808-816) T he occurrence of systemic ventricular dysfunction in a significant number of patients after Mustard and Senning operations1-3 has been documented. The cause of this dysfunction remains uncertain. It has been suggested that the right ventricle is unable to sustain systemic pressure loads in the long-term because of various morphological features4 or preoperative hypoxemia and intraoperative factors.5 Some or all of these factors may influence the left ventricle also. This has stimulated the development of anatomical correction for complete transposition of the great arteries (TGA ventricular function after anatomical correction,7-10 but little information is available on ventricular function in the medium-term.11'12 The purpose of this study was to investigate right and left ventricular function in patients who had undergone anatomical correction or intra-atrial repair operations for TGA by the same investigative methods for both groups of patients. We attempted to identify the factors contributing to right ventricular dysfunction after Mustard and Senning operations and to investigate whether left ventricular dysfunction occurred after anatomical correction. Methods Anatomical CorrectionTwenty-one patients who had undergone anatomical correction of TGA at Harefield Hospital were studied. The age of the patients at the time of the study ranged from 17 to 85 months (mean, 51.8 months). The studies were performed between 17 and 78 months after operation (mean, 47 months).

Pregnancy-Related Obstetric and Cardiologic Problems in Women After Atrial Switch Operation for Transposition of the Great Arteries

“…8, 9 The causes are multifactorial, including hypoxia, ventricular septal defect and abnormal ventricular geometry. 1, [8][9][10][11] Echocardiographic data show that all heart chambers increase in size during the course of a normal pregnancy, which Heart failure during third pregnancy Medical abortion necessary in the 16th week *ACE inhibitor was part of the regular medication but discontinued during pregnancy. ACE, angiotensin-converting enzyme; FC, functional class; SSS, sick sinus syndrome; TGA, transposition of the great arteries; VSD, ventricular septal defect.…”

Palliative Mustard operation for transposition of the great arteries: late results after 15-20 years.

“…Improvement in symptoms and signs (failure to thrive, heart failure, dyspnoea, and cyanosis) occurred initially in all patients after palliative Mustard operation and was maintained for 13-4 (4.7) years until age [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] (mean (SD) (5) Time after operation (years) Figure 1 Development of heartfailure (HF) and cyanosis (CY) with change in Ability Index (AI) in time after palliative Mustard operation. quent heart failure which was controlled by digoxin and diuretics; since then, the patient has experienced no further deterioration in symptoms or functional state and her ability index remains at 2 20 years after the procedure.…”

“…Tricuspid regurgitation had developed in seven patients by the age of 14-5-31 (mean (SD) 22-4 (5.4)), [8][9][10][11][12][13][14][15][16][17][18] (mean (SD) 13 (3)) years after the operation (figs 3 and 4) and was trivial in three (nos 1, 7, and 8), moderate in two (nos 4 and 5), and severe in two (nos 6 and 10), although only one was symptomatic.…”

“…[3][4][5] Knowledge about the state and fate in adults is sparse. This study reports the findings in all adults patients seen in the Grown-up Congenital Heart Unit during the past [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] (mean (SD) 11 (5.7)) years, 15-20 years after palliative Mustard operation.…”

Palliative mustard operation for transposition of the great arteries: Late results after 15–20 years

“…[3][4][5] Knowledge about the state and fate in adults is sparse. This study reports the findings in all adults patients seen in the Grown-up Congenital Heart Unit during the past [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] (mean (SD) 11 (5.7)) years, 15-20 years after palliative Mustard operation.…”