Cardiac mri strain analysis demonstrates systemic right ventricular dysfunction late after atrial switch procedure despite normal ejection fraction

Karen Smith,Wojciech Mazur,Kan N Hor,Robert J Fleck,Janaka P Wansapura,William M Gottliebson,D Woodrow Benson

doi:10.1186/1532-429x-12-s1-p24

Abstract

Introduction The atrial switch operation (ASO), performed routinely until the early 1990's for d-Transposition of the Great Arteries (d-TGA), resulted in a systemic right ventricle (SRV). Anecdotal qualitative data has suggested that the RV is doomed to progressive dysfunction and eventual systolic failure when placed in the systemic circulation over the long term. Quantitative analysis of SRV function after ASO has only recently been available via cardiac MRI (CMR) assessment of SRV Ejection Fraction (EF), an index that has proven to be somewhat insensitive to subtle cardiac dysfunction in other cardiac conditions. We hypothesized that CMR-based myocardial strain (e) assessment would prove a more sensitive indicator of cardiac dysfunction than SRV EF in ASO subjects.

Highlights

The atrial switch operation (ASO), performed routinely until the early 1990's for d-Transposition of the Great Arteries (d-TGA), resulted in a systemic right ventricle (SRV)
Quantitative analysis of SRV function after ASO has only recently been available via cardiac MRI (CMR) assessment of SRV Ejection Fraction (EF), an index that has proven to be somewhat insensitive to subtle cardiac dysfunction in other cardiac conditions
Mean SRV εcc magnitude for all post ASO subjects was lower than systemic ventricular εcc magnitude in controls, regardless of EF status, and was lower still for ASO subjects with abnormal SRV EF

Summary

Introduction

The atrial switch operation (ASO), performed routinely until the early 1990's for d-Transposition of the Great Arteries (d-TGA), resulted in a systemic right ventricle (SRV). Anecdotal qualitative data has suggested that the RV is doomed to progressive dysfunction and eventual systolic failure when placed in the systemic circulation over the long term. Quantitative analysis of SRV function after ASO has only recently been available via cardiac MRI (CMR) assessment of SRV Ejection Fraction (EF), an index that has proven to be somewhat insensitive to subtle cardiac dysfunction in other cardiac conditions. We hypothesized that CMR-based myocardial strain (ε) assessment would prove a more sensitive indicator of cardiac dysfunction than SRV EF in ASO subjects. Determine the changes in myocardial strain in a cross section of ASO patients

Methods

Results

Conclusion