Exercise Capacity Long-Term after Arterial Switch Operation for Transposition of the Great Arteries

Samos, Flávia; Fuenmayor, Gabriela; Hossri, Carlos Alberto Cordeiro; Eliás, P; Ponce, Leandro; Souza, Rogério; Jatene, Ieda Biscegli

doi:10.1111/chd.12303

Cited by 17 publications

(16 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The long-term clinical effect of increased RV afterload in ASO patients warrants life-long monitoring. Arterial switch operation patients generally demonstrate normal RV ejection fraction 4 ; however, their exercise capacity is at least borderline low compared to the normal population, [28][29][30] and exercise limitation has been correlated with smaller PA sizes and maldistribution of pulmonary blood flow. 31,32 Subtle impairments in RV function also persist after surgical repair, such as decreased RV free wall strain and decreased systolic/diastolic tissue Doppler imaging velocities.…”

Section: Commentmentioning

confidence: 99%

Abnormal Pulmonary Artery Bending Correlates With Increased Right Ventricular Afterload Following the Arterial Switch Operation

Loke

Capuano

Mandell

et al. 2019

World J Pediatr Congenit Heart Surg

View full text Add to dashboard Cite

Purpose: In transposition of great arteries, increased right ventricular (RV) afterload is observed following arterial switch operation (ASO), which is not always related to pulmonary artery (PA) stenosis. We hypothesize that abnormal PA bending from the Lecompte maneuver may affect RV afterload in the absence of stenosis. Thus, we sought to identify novel measurements of three-dimensional cardiac magnetic resonance (CMR) images of the pulmonary arteries and compare with conventional measurements in their ability to predict RV afterload. Methods: Conventional measurements and novel measurements of the pulmonary arteries were performed using CMR data from 42 ASO patients and 13 age-matched controls. Novel measurements included bending angle, normalized radius of curvature ( Rc), and normalized weighted radius of curvature ( Rc- w). Right ventricular systolic pressures (as the surrogate for RV afterload) were measured by either recent echocardiogram or cardiac catheterization. Results: Conventional measurements of proximal PA size correlated with differential pulmonary blood flow ( r = 0.49, P = .001), but not with RV peak systolic pressures ( r = −0.26, P = .18). In ASO patients, Rc- w correlated with higher RV systolic pressures ( r = −0.57, P = .002). Larger neoaortic areas and rightward bending angles correlated with smaller right pulmonary artery Rc ( r = −0.48, P = .001; r = 0.41, P = .01, respectively). Finally, both pulmonary arteries had significantly smaller Rc compared to normal controls. Conclusions: Pulmonary arteries exhibit abnormal bends following ASO that correlate with increased RV afterload, independent of PA stenosis. Future work should focus on clinical and hemodynamic contributions of these shape parameters.

show abstract

Section: Commentmentioning

confidence: 99%

Abnormal Pulmonary Artery Bending Correlates With Increased Right Ventricular Afterload Following the Arterial Switch Operation

Loke

Capuano

Mandell

et al. 2019

World J Pediatr Congenit Heart Surg

View full text Add to dashboard Cite

show abstract

“…The overall long-term outcomes of Transposition of the Great Arteries patients have been described as excellent, 26 although lower longterm exercise capacity has been observed in some Transposition of the Great Arteries patients due to the presence of a chronotropic incompetence. 27 A Ventricular Septal Defect is normally closed in early childhood and children are post-surgically considered healthy and fit. However, it has been described that young adults with surgically corrected Ventricular Septal Defect have reduced cardiopulmonary exercise capacity and significantly lower physical functioning scores compared to healthy controls.…”

Section: Discussionmentioning

confidence: 99%

Impact of congenital heart surgery on quality of life in children and adolescents with surgically corrected Ventricular Septal Defect, Tetralogy of Fallot, and Transposition of the Great Arteries

et al. 2019

View full text Add to dashboard Cite

Objective:To describe the impact of CHD surgery in early childhood on quality of life in children aged 10–16 years with surgically corrected Ventricular Septal Defect, Transposition of the Great Arteries, and Tetralogy of Fallot.Method:A cross-sectional survey study of quality of life survey on 161 children and adolescents aged 10–16 years with surgically corrected Ventricular Septal Defect, Transposition of the Great Arteries, and Tetralogy of Fallot. The international Paediatric Quality of Life 4.0 quality of life questionnaires were applied and collected for assessment from patients and parents. The endpoints were total, physical, emotional, social, and school quality of life scores.Results:The quality of life total and school scores was significantly lower in children with CHD than their healthy peers. There was no significant difference in quality of life between the three CHD groups. All three CHD groups had a significantly lower total (7.7–13.2%, p<0.001) and school scores (21.1–31.6%, p<0.001) than the control group. The tetralogy of Fallot group was the only group that had significantly lower scores in the physical subscale (p<0.001) than the controls.Conclusion:Children and adolescents with surgically corrected CHD show losses in quality of life in total and school scores compared to healthy controls. The tetralogy of Fallot group was the only CHD group that had significantly lower physical score than the controls.

show abstract

“…During follow-up after delivery, no woman showed deterioration of NYHA functional class or systemic ventricular dysfunction, with the exception of increased pulmonary or aortic regurgitation in 2 cases. Several authors reported that ASO survivors show better cardiac function, exercise performance, self-reported quality of life, and fewer somatic complaints compared to Mustard patients [8,21,7]. Because the systemic ventricle was corrected to the left ventricle, physiological loads such as pregnancy may have a reduced adverse impact on cardiac function in women after ASO, compared to a systemic right ventricle such as in the atrial switch group.…”

Section: Prognosis After Deliverymentioning

confidence: 99%

“…The progression to ASO had positive impact on systemic ventricular function, morbidity, and exercise capacity long-term follow-up [7,8]. The systemic left ventricle could be treated with better mid-and long-term outcomes, compared to the systemic right ventricle.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy outcomes and mid-term prognosis in women after arterial switch operation for dextro-transposition of the great arteries – Tertiary hospital experiences and review of literature

Horiuchi

Kamiya

Ohuchi

et al. 2019

Journal of Cardiology

View full text Add to dashboard Cite

Arterial switch operation (ASO) for dextro-transposition of the great arteries (d-TGA) has gradually replaced the atrial switch operation and has become the standard operation. To date, the outcomes of pregnant women with d-TGA after this new operation have not been investigated. In this study, we investigated the impact of ASO on pregnant outcomes and mid-term prognosis in women with d-TGA and compared with the atrial switch operation through the literature review. Methods and results: There were 20 pregnancies in 10 women with d-TGA after ASO and 6 resulted in abortion. Among 14 successful pregnancies in 10 women, 11 pregnancies achieved the term delivery and 3 pregnancies, including 1 twin pregnancy, resulted in preterm labor. Maternal cardiovascular events occurred in 4 (heart failure and arrhythmias in 3 and arrhythmia in 1), and all were controllable with medications. Risk factors for the peripartum cardiac events were older age at ASO and delivery, and higher concentration of brain natriuretic peptide (BNP) at first trimester (p < 0.05). In 7-60 monthfollow-up after delivery, no case showed deterioration of functional class and systemic ventricular function. According to the literature review, women after ASO demonstrated a better prognosis than those after the atrial switch operation. Conclusions: The majorityof womenwith d-TGA afterASO tolerated pregnancyand delivery well. The olderage at ASO, an elderly pregnancy, and higher BNP levels at the first trimester were possibly risk factors of peripartum cardiovascular events among the group. The literature reviews and this study may indicate the advantage of systemic left ventricle compared with systemic right ventricle in long-term outcomes after delivery.

show abstract

Exercise Capacity Long-Term after Arterial Switch Operation for Transposition of the Great Arteries

Abstract: Our results showed that exercise capacity long-term after ASO in TGA is well preserved although lower than in healthy children what might be explained by the presence of chronotropic incompetence in the TGA group.

Cited by 17 publications

References 20 publications

Abnormal Pulmonary Artery Bending Correlates With Increased Right Ventricular Afterload Following the Arterial Switch Operation

Abnormal Pulmonary Artery Bending Correlates With Increased Right Ventricular Afterload Following the Arterial Switch Operation

Impact of congenital heart surgery on quality of life in children and adolescents with surgically corrected Ventricular Septal Defect, Tetralogy of Fallot, and Transposition of the Great Arteries

Pregnancy outcomes and mid-term prognosis in women after arterial switch operation for dextro-transposition of the great arteries – Tertiary hospital experiences and review of literature

Contact Info

Product

Resources

About