CLINICAL STUDY: PEDIATRIC CARDIOLOGY
Myocardial perfusion and function of the systemic right ventricle in patients after atrial switch procedure for complete transposition: long-term follow-up
Barbara Lubiszewska, MD*,
Elzbieta Gosiewska, MD ,
Piotr Hoffman, MD, PhD ,
Anna Teresi ska, MSc,
Jacek Ró aski, MD ,
Walerian Piotrowski, MSc||,
Wanda Rydlewska-Sadowska, MD, PhD, FESC,
Krystyna Kubicka, MD, PhD¶ and
Witold Ruy o, MD, PhD, FESC*
* Department of General Cardiology, Epidemiology and Prevention, National Institute of Cardiology Warsaw, Warsaw, Poland
Division of Nuclear Medicine, Epidemiology and Prevention, National Institute of Cardiology Warsaw, Warsaw, Poland
Department of Noninvasive Cardiology, Epidemiology and Prevention, National Institute of Cardiology Warsaw, Warsaw, Poland
Department of Cardiac Surgery, Epidemiology and Prevention, National Institute of Cardiology Warsaw, Warsaw, Poland
|| Department of Cardiovascular Diseases, Epidemiology and Prevention, National Institute of Cardiology Warsaw, Warsaw, Poland
¶ Department of Cardiology, Children’s Memorial Health Institute, Warsaw, Poland
Manuscript received June 10, 1999;
revised manuscript received March 27, 2000,
accepted June 1, 2000.
Reprint requests and correspondence: Dr. Barbara Lubiszewska, Department of General Cardiology, National Institute of Cardiology, 04-628 Warsaw, Alpejska 42, Poland
biblnauk{at}ikard.waw.pl
OBJECTIVES
Our purpose was to assess the right ventricular (RV) function and identify patients with RV impairment long after the Mustard or Senning operation.
BACKGROUND
Systemic ventricular failure can cause myocardial perfusion abnormalities in thallium scintigraphy correlating with hemodynamic deterioration.
METHODS
Myocardial perfusion at rest and at peak exercise was assessed in 61 patients, aged 7 to 23 years in mean time 10.0 ± 2.9 years after surgery using technetium-99m methoxyisobutyl isonitrile single-photon emission computed tomography. Ventricular function was assessed by first-pass radionuclide angiography at rest. Exercise capacity was determined with a modified Bruce protocol.
RESULTS
The mean RV ejection fraction was 36.1 ± 7.7%, and left ventricular (LV) ejection fraction was 52.1 ± 9.4%. Moderate or severe perfusion abnormalities on the rest scan were observed in 20 patients (33%). On exercise perfusion worsened in another 13 patients (21.3%). Patients with perfusion defects on stress scan had significantly lower RV and LV ejection fraction (33.2 vs. 39.4%; p = 0.002 and 49.2 vs. 55.5%; p = 0.01, respectively). They were also older (16.6 vs.13.0 years; p = 0.002), operated on at an older age (4.0 vs. 2.4 years; p = 0.05) and had longer follow-up (12.5 vs. 10.5 years; p = 0.003).
CONCLUSIONS
Myocardial perfusion defects are common findings in patients in long-term follow-up after atrial switch operation. Despite excellent exercise tolerance, the extent of myocardial perfusion abnormalities correlated well with impaired RV and LV function, and greater perfusion defects were seen more frequently in older patients with longer follow-up. It is likely that myocardial perfusion defects could be a sensitive predictor of systemic ventricular impairment.
|
Abbreviations and Acronyms
| | ECG | = electrocardiogram | | LVEF | = left ventricular ejection fraction | | LV | = left ventricle or ventricular | | LVOTO | = left ventricular outflow tract obstruction | | RVEF | = right ventricular ejection fraction | | RV | = right ventricle or ventricular | | SD | = standard deviation | | SPECT | = single-photon emission computed tomography | | TGA | = complete transposition | | VSD | = ventricular septal defect |
|
This article has been cited by other articles:
|
|
|
|
 
J Janousek, R A Gebauer, H Abdul-Khaliq, M Turner, L Kornyei, O Grollmuss, E Rosenthal, E Villain, A Fruh, T Paul, et al.
Cardiac resynchronisation therapy in paediatric and congenital heart disease: differential effects in various anatomical and functional substrates
Heart,
July 15, 2009;
95(14):
1165 - 1171.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P-C Chow, X-C Liang, E W Y Cheung, W W M Lam, and Y-F Cheung
New two-dimensional global longitudinal strain and strain rate imaging for assessment of systemic right ventricular function
Heart,
July 1, 2008;
94(7):
855 - 859.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S Fratz, M Hauser, F M Bengel, A Hager, H Kaemmerer, M Schwaiger, J Hess, and H C Stern
Myocardial scars determined by delayed-enhancement magnetic resonance imaging and positron emission tomography are not common in right ventricles with systemic function in long-term follow up
Heart,
November 1, 2006;
92(11):
1673 - 1677.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. M. Paridon, B. S. Alpert, S. R. Boas, M. E. Cabrera, L. L. Caldarera, S. R. Daniels, T. R. Kimball, T. K. Knilans, P. A. Nixon, J. Rhodes, et al.
Clinical Stress Testing in the Pediatric Age Group: A Statement From the American Heart Association Council on Cardiovascular Disease in the Young, Committee on Atherosclerosis, Hypertension, and Obesity in Youth
Circulation,
April 18, 2006;
113(15):
1905 - 1920.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. F. Tops, A. A. W. Roest, H. J. Lamb, H. W. Vliegen, W. A. Helbing, E. E. van Der Wall, and A. de Roos
Intraatrial Repair of Transposition of the Great Arteries: Use of MR Imaging after Exercise to Evaluate Regional Systemic Right Ventricular Function
Radiology,
December 1, 2005;
237(3):
861 - 867.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L Dos, L Teruel, I J Ferreira, J Rodriguez-Larrea, L Miro, J Girona, D C Albert, A Goncalves, M Murtra, and J Casaldaliga
Late outcome of Senning and Mustard procedures for correction of transposition of the great arteries
Heart,
May 1, 2005;
91(5):
652 - 656.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. V. Babu-Narayan, O. Goktekin, J. C. Moon, C. S. Broberg, G. A. Pantely, D. J. Pennell, M. A. Gatzoulis, and P. J. Kilner
Late Gadolinium Enhancement Cardiovascular Magnetic Resonance of the Systemic Right Ventricle in Adults With Previous Atrial Redirection Surgery for Transposition of the Great Arteries
Circulation,
April 26, 2005;
111(16):
2091 - 2098.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Dodge-Khatami, A. Kadner, F. Berger, H. Dave, M. I. Turina, and R. Pretre
In the Footsteps of Senning: Lessons Learned From Atrial Repair of Transposition of the Great Arteries
Ann. Thorac. Surg.,
April 1, 2005;
79(4):
1433 - 1444.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. Li, T. S. Hornung, D. P. Francis, C. O'Sullivan, A. Duncan, M. Gatzoulis, and M. Henein
Relation of Biventricular Function Quantified by Stress Echocardiography to Cardiopulmonary Exercise Capacity in Adults With Mustard (Atrial Switch) Procedure for Transposition of the Great Arteries
Circulation,
September 14, 2004;
110(11):
1380 - 1386.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J.W Roos-Hesselink, F.J Meijboom, S.E.C Spitaels, R van Domburg, E.H.M van Rijen, E.M.W.J Utens, J McGhie, E Bos, A.J.J.C Bogers, and M.L Simoons
Decline in ventricular function and clinical condition after mustard repair for transposition of the great arteries (a prospective study of 22-29 years)
Eur. Heart J.,
July 2, 2004;
25(14):
1264 - 1270.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A A W Roest, H J Lamb, E E van der Wall, H W Vliegen, J G van den Aardweg, P Kunz, A de Roos, and W A Helbing
Cardiovascular response to physical exercise in adult patients after atrial correction for transposition of the great arteries assessed with magnetic resonance imaging
Heart,
June 1, 2004;
90(6):
678 - 684.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Vogel, G. Derrick, P. A. White, S. Cullen, H. Aichner, J. Deanfield, and A. N. Redington
Systemic ventricular function in patients with transposition of the great arteries after atrial repair: a tissue Doppler and conductance catheter study
J. Am. Coll. Cardiol.,
January 7, 2004;
43(1):
100 - 106.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
