CLINICAL STUDIES
Role of ischemia and infarction in late right ventricular dysfunction after atrial repair of transposition of the great arteries
Teri Millane, MD, MRCP*,
Elizabeth J. Bernard, FRACP ,
Edgar Jaeggi, MD*,
Robert B. Howman-Giles, MD, FRACP, DDU,
Roger F. Uren, FRACP, DDU,
Timothy B. Cartmill, FRACS ,
Richard E. Hawker, FRACP* and
David S. Celermajer, PhD, FRACP* 
* Department of Cardiology, New Children’s Hospital, Sydney, NSW Australia
Department of Nuclear Medicine, New Children’s Hospital, Sydney, NSW Australia
Department of Surgery, New Children’s Hospital, Sydney, NSW Australia
Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW Australia
Manuscript received July 22, 1999;
revised manuscript received October 5, 1999,
accepted January 12, 2000.
OBJECTIVES
This study was conducted to assess whether myocardial ischemia and/or infarction are involved in the pathogenesis of late right ventricular dysfunction in adult survivors of atrial baffle repair for transposition of the great arteries in infancy.
BACKGROUND
The medium-term success of intraatrial baffle repair for transposition of the great arteries is good, with many patients surviving into adult life, but prognosis can be limited by progressive right ventricular dysfunction. We hypothesized that ongoing myocardial ischemia and/or infarction are important factors in the pathogenesis of this complication. Radionuclide techniques offer an opportunity to study both myocardial perfusion and concomitant ventricular wall motion.
METHODS
Dipyridamole sestamibi single-photon emission computed tomography followed by rest sestamibi single-photon emission computed tomography was used to assess right ventricular myocardial perfusion, wall motion, wall thickening and ejection fraction in 22 adolescents/young adults who had undergone atrial baffle repair for simple transposition of the great arteries at median 6.7 (range 0.5 to 54) months of age. The patients were aged 10 to 25 (median 15.5) years; 19 in New York Heart Association class I, 2 in class II and 1 in class III. All were in a regular cardiac rhythm during the studies. The right ventricular tomographic images were examined in three parallel and two orthogonal planes, analyzed in 12 segments.
RESULTS
Perfusion defects were evident in all patients in at least one segment, in either the rest or stress images. Twelve patients (55%) demonstrated fixed defects only, nine (41%) had fixed and reversible defects and one (4.5%) had reversible defects only. Concomitant wall-thickening abnormalities occurred in 83% of segments with fixed perfusion defects, mirrored by a reduction in wall motion in 91% of segments analyzed. Right ventricular ejection fraction was correlated with age (R = 0.62; p = 0.002), and with wall-thickening abnormalities (R = 0.60; p < 0.005).
CONCLUSIONS
Reversible and fixed perfusion defects with concordant regional wall motion abnormalities occur in the right (systemic) ventricle 10 to 20 years after Mustard repair for transposition of the great arteries; this may be important in the pathogenesis of late right ventricular dysfunction in this group.
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Abbreviations and Acronyms
| | ACE | = angiotension converting enzyme | | d-TGA | = d-transposition of the great arteries | | RV | = right ventricle | | RVEF | = right ventricular ejection fraction | | SPECT | = single-photon emission computed tomography | | 99mTc | = technetium-99m | | WMA | = wall motion abnormality |
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