Role of ischemia and infarction in late right ventricular dysfunction after atrial repair of transposition of the great arteries

Millane, T; Bernard, E; Jaeggi, Edgar; Howman‐Giles, Robert; Uren, Roger F.; Cartmill, Timothy B.; Hawker, Richard E.; Celermajer, David S.

doi:10.1016/s0735-1097(00)00585-4

Cited by 127 publications

(77 citation statements)

References 22 publications

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“…Previously published nuclear medicine data have demonstrated both fixed and reversible perfusion defects in patients up to 25 years after atrial redirection surgery. 9,14 In the study by Lubiszewska et al, 9 stress-induced perfusion abnormalities correlated with increased age, later repair, and lower RVEF and LVEF. This agrees with our evidence of fibrosis correlating with increased age, increased time since repair, and decreased RVEF.…”

Section: Introductionmentioning

confidence: 94%

Late Gadolinium Enhancement Cardiovascular Magnetic Resonance of the Systemic Right Ventricle in Adults With Previous Atrial Redirection Surgery for Transposition of the Great Arteries

et al. 2005

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Background-Patients treated for transposition of the great arteries by atrial redirection surgery have a right ventricle (RV) that sustains systemic pressures long term. Late RV dysfunction occurs in these patients; the reasons for this are unclear, but myocardial fibrosis may be important. Myocardial fibrosis can be visualized by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR). We hypothesized that LGE would be present in the systemic RV and relate to adverse clinical features. Methods and Results-We performed CMR on 36 consecutive adult patients (mean age, 27 years) after atrial redirection surgery for transposition of the great arteries. Late gadolinium RV enhancement was seen in 22 patients (61%) with various patterns. Patients with RV LGE were older (30 versus 22 years; PϽ0.001) and had increased RV end-systolic volume index (43 versus 35 mL/m 2 ; Pϭ0.03), decreased RV ejection fraction (57% versus 62%; Pϭ0.02), increased QRS duration (108 versus 97 ms; Pϭ0.01), and increased QT dispersion (93 versus 71 ms; Pϭ0.002). The extent of LGE correlated with age (rϭ0.59, PϽ0.001) and QRS duration (rϭ0.67, PϽ0.001) and inversely with RV ejection fraction (rϭϪ0.76, PϽ0.001). The incidence of documented arrhythmia and/or syncope (10 of 36) was significantly higher in the late gadolinium-positive group (9/22 versus 1/14; Pϭ0.03). Key Words: heart ventricles Ⅲ magnetic resonance imaging Ⅲ heart defects, congenital Ⅲ transposition of great vessels Ⅲ fibrosis B efore use of the arterial switch operation, patients with transposition of the great arteries were palliated by redirection of blood at the atrial level with the Senning 1 or Mustard operation. 2 There is a contemporary adult population in whom the right ventricle (RV) must sustain systemic pressure long term. Late RV dysfunction is common in these patients 3 and may be related to myocardial fibrosis. In patients with a systemic left ventricle (LV), cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) can detect myocardial fibrosis in both ischemic and nonischemic cardiomyopathies. 4,5 We hypothesized that LGE would be present in the systemic RV and that it would be associated with markers of adverse clinical outcome. 4 Conclusions-LGE Methods Patient PopulationConsecutive patients with transposition of the great arteries who had undergone either the Mustard or Senning procedure were invited to participate. Patients with a permanent pacemaker in situ were excluded. The local research ethics committee approved the study, and all patients gave written informed consent. Cardiovascular Magnetic ResonanceA 1.5-T scanner was used (Siemens Sonata). After routine assessment of anatomy, the patency of atrial pathways and function of valves were assessed by steady-state free precession (SSFP) cine imaging in a sequence of specified oblique planes. They were aligned with each atrial pathway, the inflow valves in long-axis planes, and the outflow tracts. Peak velocity was measured at the narrowest point of each caval pathwa...

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Section: Introductionmentioning

confidence: 94%

Late Gadolinium Enhancement Cardiovascular Magnetic Resonance of the Systemic Right Ventricle in Adults With Previous Atrial Redirection Surgery for Transposition of the Great Arteries

et al. 2005

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“…7,33, 34 In both groups of patients in the present study (ccTGA, AtSO), chronic pressure overload was compensated by hypertrophy of the morphologic systemic RV. Although this mechanism is initially an adaptive response that temporarily augments or maintains cardiac output, reduced capillary density in relation to the hypertrophied myocardium with consequent reduced MBF may be a leading cause of the development of systolic and diastolic heart failure, electrical instability and sudden death.…”

Section: Petmentioning

confidence: 49%

Myocardial Blood Flow in Patients With Transposition of the Great Arteries

Hauser

Meierhofer

Schwaiger³

et al. 2015

Circ J

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“…(17)(18)(19) Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have previously been shown to decrease myocardial fibrosis and attenuate ventricular remodelling with a resultant increase in myocardial function and decrease in mortality in patients with both asymptomatic and symptomatic left ventricular dysfunction. (20)(21)(22)(23) There have been several small trials using ACEIs and ARBs in patients with a systemic RV but results have been disappointing.…”

Section: Spring 2013mentioning

confidence: 99%

Management of advanced adult congenital heart disease

Bowater

2017

SAHJ

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As surgical techniques continue to develop, for example as seen with the Norwood procedure for hypoplastic left heart syndrome, the number of patients with the most complex forms of CHD will continue to increase along with their associated long term complications. Our ability to manage these patients appropriately, therefore, must also develop alongside. The purpose of this review is to examine the management of these patients once they have developed advanced disease, including drug therapy, devices, transplant and end of life care. In particular, the unique problems posed by patients with a systemic right ventricle (RV) and univentricular circulations are discussed. DRUG THERAPY IN HEART FAILUREIn patients with complex congenital heart disease, either palliated or unoperated, the development of ventricular dysfunction and clinical heart failure are common and as discussed above, is a common cause of morbidity and mortality in this population.

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Role of ischemia and infarction in late right ventricular dysfunction after atrial repair of transposition of the great arteries

Cited by 127 publications

References 22 publications

Late Gadolinium Enhancement Cardiovascular Magnetic Resonance of the Systemic Right Ventricle in Adults With Previous Atrial Redirection Surgery for Transposition of the Great Arteries

Late Gadolinium Enhancement Cardiovascular Magnetic Resonance of the Systemic Right Ventricle in Adults With Previous Atrial Redirection Surgery for Transposition of the Great Arteries

Myocardial Blood Flow in Patients With Transposition of the Great Arteries

Management of advanced adult congenital heart disease

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