Timely Detection of Subclinical Heart Failure Among Children with D-Transposition of Great Arteries after Senning Operation: A Single Center Experience

Abstract

Background: Atrial switch operation, was introduced by Ake Senning in 1958 for patients with D-transposition of great arteries (D-TGA). The major disadvantage of the atrial switch procedure is right ventricle (RV) failure in up to 7% to 10% of patients per 10 years. Aims of the work:To detect subclinical RV failure in children with D-TGA after atrial switch repair using conventional and nonconventional echocardiography. Subjects and Methods: We studied 25 children with D-TGA who underwent atrial switch operation following in the Postoperative Cardiology Clinic at Cairo University Specialized Pediatric Hospital. They did not have symptoms of heart failure. They underwent conventional echocardiography, tissue Doppler and speckle tracking imaging including RV global longitudinal strain (RV GLS) to detect subclinical heart failure according to New York Heart Association (NYHA) classification. The results were compared to a matched control group. Results: Mean age ± standard deviation of the studied group was 6.8 ± 4.3 years while mean age at time of operation ranged 14.2 ± 12.7 months (p=0.001). Mean RV global longitudinal strain (GLS) of cases (-14.5± 1.5%) was significantly impaired compared to RV GLS of controls (-20.2 ± 1.4%) (p <0.001). Tricuspid annular plane systolic excursion (TAPSE) of cases (12.7 ± 3.1 mm) was lower than TAPSE of controls (15.5 ± 2.3 mm) (p= 0.001). While RV myocardial performance index (MPI) of cases (0.47 ± 0.10) was higher than RV MPI of controls (0.34 ± 0.03) (p <0.001). There was a negative correlation between age at the time of surgery and RV GLS (r = -0.435) (p = 0.030). Non-conventional echocardiographic parameters RV MPI and RV GLS detected subclinical heart failure among all studied cases post-atrial switch. Conclusions: Non-conventional echocardiographic parameters RV MPI and RV GLS had higher sensitivity for detection of RV dysfunction and timely diagnosis of subclinical heart failure in patients of D-TGA after Senning atrial switch operation that was not detected by conventional echocardiography. Level of Evidence of Study: IV (1).