Evaluation of Right Ventricular Performance Long After the Atrial Switch Operation for Transposition of the Great Arteries Using the Doppler Tei Index

Abstract

Right ventricular (RV) dysfunction may occur in patients after the atrial switch operation for d-transposition of the great arteries (d-TGA) and can be an important complication. Noninvasive assessment of RV function using echocardiography is necessary for following up these patients. We evaluated RV function using the Doppler Tei index (RV Tei index). The RV Tei index measures the ratio of total time intervals in isovolumetric contraction and relaxation to the ejection time. The subjects consisted of 33 patients who had undergone the atrial switch operation for d-TGA (the atrial switch group) (mean age, 21 +/- 4 years), 10 patients with pulmonary artery stenosis after the arterial switch operation for d-TGA (the arterial switch group) (mean age, 17 +/- 1 years), and 10 patients with a normally structured heart as a control group (mean age, 26 +/- 7 years). The RV Tei index (0.65 +/- 0.16) was significantly higher in the atrial switch group than in the arterial switch group (0.29 +/- 0.07) and the control group (0.29 +/- 0.01) (p < 0.05). The fractional area change of the RV obtained from the four-chamber view in the atrial switch group showed a significant negative correlation with the RV Tei index (r = -0.58, p < 0.01). The RV Tei index increased with increasing severity of the NYHA functional class. In the moderate/severe tricuspid regurgitation group, it was significantly higher than in patients with none/trivial tricuspid regurgitation. We conclude that the RV Tei index is useful for evaluating RV junction long after the atrial switch operation for d-TGA.