Abstract
Long-term after arterial switch operation for transposition of the great arteries, abnormal coronary anatomy and altered loading conditions could compromise ventricular function. The current study investigates whether left ventricular function, measured with echocardiographic bi-plane ejection fraction and deformation imaging, in patients long term after arterial switch operation for transposition of the great arteries differs from healthy peers. A cross-sectional cohort study of patients at least 12 years after arterial switch operation was analyzed with bi-plane Simpson’s left ventricular ejection fraction (LVEF) and deformation (speckle tracking) echocardiography. 81 patients, median age 20.6 (interquartile range 13.5–28.4) years, were included. LVEF was normal on average at 55.5 ± 6.1%. Global longitudinal strain (GLS) was lower in patients compared to healthy peers throughout all age groups and on pooled average (− 15.4 ± 1.1% vs. − 23.2 ± 0.9%). Although LVEF is normal on average in patients after arterial switch operation for transposition of the great arteries, GLS is impaired compared to healthy peers. The reduced GLS could indicate sub-clinical myocardial dysfunction.
Highlights
The arterial switch operation is the standard procedure for correcting transposition of the great arteries [1]
These considerations, together with the knowledge that eventually a considerable number of adult patients with congenital heart disease will die from ventricular failure [9], make it likely that left ventricular (LV) dysfunction will develop in a substantial portion of this specific patient population
Pettersen et al [15] and Di Salvo et al [16] reported abnormal global longitudinal strain (GLS) in pediatric patients, but data on deformation imaging in adults after arterial switch operation have not been reported
Summary
The arterial switch operation is the standard procedure for correcting transposition of the great arteries [1]. The presence of a circular vascular anastomosis a few centimeters distal of the aortic valve, and the acute angle of the aortic arch ( known as a gothic arch [8]) that develops in a majority of patients could cause increased afterload These considerations, together with the knowledge that eventually a considerable number of adult patients with congenital heart disease will die from ventricular failure [9], make it likely that LV dysfunction will develop in a substantial portion of this specific patient population. Pettersen et al [15] and Di Salvo et al [16] reported abnormal global longitudinal strain (GLS) in pediatric patients, but data on deformation imaging in adults after arterial switch operation have not been reported. Inter- and intra-observer reproducibility was checked through blinded reanalysis of random selected sample of 20 patients and tested with intraclass correlation coefficients
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