Neoaortic Regurgitation in Patients with Transposition Long Term After an Arterial Switch Operation and Its Relation to the Root Diameters and Surgical Technique Used

Abstract

Neoaortic regurgitation and root dilatation are common findings in patients with transposition after an arterial switch operation. The aim of this study was to describe the relation between neoaortic regurgitation long term after an arterial switch procedure, aortic root diameters, and surgical technique used. We also assessed the agreement of the neoaortic regurgitation grade and root diameters in different imaging modalities. For this retrospective study, we qualified 56 consecutive patients who, according to our institutional protocol, had a routine postoperative evaluation of more than 16 years with multimodality imaging studies. Neoaortic regurgitation was assessed by both transthoracic echocardiography and magnetic resonance imaging, and the root diameters obtained by echocardiography and tomography were compared to the reference values and associated with the presence of neoaortic insufficiency. Neoaortic insufficiency was present in 75% of examined patients; the vast majority of them had trace or mild regurgitation, and its qualitative evaluation was significantly different between echocardiography and magnetic resonance imaging. In our study group, the neoaortic valve and aortic sinus were larger in relation to the normal values, and they were significantly correlated with the presence of neoaortic insufficiency, but not with the surgical technique used. Values obtained by echocardiography and tomography correlated well but were significantly different. Transthoracic echocardiography has a tendency to overestimate the severity of regurgitation compared to magnetic resonance imaging. Neoaortic valve and sinus dilatation are significantly correlated with valve insufficiency, but in most cases of root dilatation, the valve remains competent.

The impact of a bicuspid pulmonary valve in the aortic position after arterial switch for transposition of the great arteries on neoaortic root dimension and function: a propensity score matched analysis

“…As previously mentioned, the neoaortic sinus growth seemed more prominent in the tricuspid group, although an increasing trend was also observed in the bicuspid group. Unlike the findings from previous studies ( 14 , 16 ), in our study, the progression of neoAR was more prominent in the bicuspid group, in which the outgrowth of the neoaortic sinus was less prominent. This finding suggests that the neoaortic valve function might be affected by the neoaortic valve itself rather than by the neoaortic root pathology.…”

Neoaortic Regurgitation Detected by Echocardiography After Arterial Switch Operation

“…Our initial search yielded 344 unique citations ( Supplemental Table 1 ); among these, 30 fulfilled our eligibility criteria ( Figure 1 ). 4 , 5 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 Characteristics of each study and their participants are shown in Table 1 . The 30 included studies comprised a total of 6,169 patients and were conducted in 13 different countries across 3 continents.…”

CT and MRI for Repaired Complex Adult Congenital Heart Diseases

“…A dilated neoaortic root not only leads to neoaortic valve regurgitation (9% increase in the hazard of aortic regurgitation ≥ moderate per mm increase in aortic root diameter) ( Fig. 14 ) but also to coronary artery compression ( 47 48 49 ).…”

“…CT has an established role in aortic evaluation ( 49 ), and the transferred coronary arteries can be simultaneously assessed ( 16 39 ). On the other hand, in addition to the morphologic evaluation, MRI allows quantitative assessment of neoaortic valve regurgitation ( 49 ).…”