Features of the right atrium in repaired dextro-transposition of the great arteries following atrial switch operations (Insights from the CSONGRAD Registry and MAGYAR-Path Study)

Abstract

Background In dextro-transposition of the great arteries (dTGA), the aorta and the pulmonary artery are transposed. The present study aimed a three-dimensional speckle-tracking echocardiography-derived determination of volumetric and functional features of the atrium being on the morphologic right side [‘right atrium (RA)] in adult patients with dTGA. Methods The present study comprised 18 adult dTGA patients, four of whom were excluded due to inferior image quality. From the remaining 14 patients (mean age: 29.7 ± 8.1 years, 9 males), 7 cases underwent Mustard-procedure, while another 7 subjects underwent Senning-procedure. Their results were compared to that of 28 age- and gender-matched healthy subjects (28.8 ± 1.4 years, 20 males). Results Increased RA volumes respecting the cardiac cycle could be demonstrated in dTGA patients compared to controls. RA stroke volumes (SVs) for reservoir and conduit function were reduced together with impaired RA emptying fractions (EFs) featuring all phases of RA function. Mustard-operated patients showed tendentiously lower RA volumes and increased SVs and EFs respecting the cardiac cycle compared to those of Senning-operated patients suggesting beneficial results for Mustard-procedure. Reduced RA global and mean segmental peak RA strains and RA strains at atrial contraction could be detected in dTGA patients compared to those of controls with tendentiously lower values in Mustard-operated patients compared to those of Senning-operated subjects. Conclusions Significant RA volumetric and functional abnormalities could be detected in adult dTGA patients following atrial switch repair. While RA volumetric data proved to be better in Mustard-operated patients, RA strains were enhanced in Senning-operated subjects.

The mitral annulus in transposition of the great arteries late after Senning- and Mustard-procedures (Insights from the CSONGRAD Registry and MAGYAR-Path Study)

“…Although Senningand Mustard-procedures are 'old-fashioned' procedures now and not used clinically anymore, patients treated with such operations could appear in the clinical practice (1)(2)(3)(4)(5)(6). According to the literature, limited information is available regarding to dTGA-associated changes in myocardial mechanics and valvular morphology and function late after atrial switch operations (15)(16)(17). In earlier studies from the MAGYAR-Path Study, significant LA volumetric and functional abnormalities could be detected more beneficial long-term effects for Senningprocedure compared to the Mustard-procedure (15).…”

“…In earlier studies from the MAGYAR-Path Study, significant LA volumetric and functional abnormalities could be detected with more beneficial long-term effects for Senning-procedure compared to the Mustard-procedure ( 15 ). For RA, volumetric data were beneficial for Mustard-operated patients, while RA strains were more advantageous in subjects late after Senning-procedure suggesting some differences between the atria ( 16 ). In dTGA, dilated end-systolic and end-diastolic TA was found which was associated with deteriorated TA functional properties regardless of the atrial switch procedure performed ( 17 ).…”

“…Moreover, laboratory, routine electrocardiographic and echocardiographic findings proved to be normal. The Motion Analysis of the heart and Great vessels bY three-dimensionAl speckle-tRacking echocardiography in Pathological cases (MAGYAR-Path) Study was organized at our department for detailed assessment of diagnostic and prognostic significance of 3DSTE-derived parameters in different pathological states including dTGA ('Magyar' means 'Hungarian' in Hungarian language) (15)(16)(17). Data collection was completed in 2019.…”