CLINICAL RESEARCH: CONGENITAL HEART DISEASE
Systemic ventricular function in patients with transposition of the great arteries after atrial repair: a tissue Doppler and conductance catheter study
Michael Vogel, MD, PhD*,
Graham Derrick, MB, BS ,
Paul A. White, PhD,
Seamus Cullen, MB, CH*,
Heidi Aichner, MD*,
John Deanfield, MB, BS* and
Andrew N. Redington, MD, FRCP ,*
* GUCH Unit Heart Hospital, London, United Kingdom
Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust, Toronto, Canada
Division of Cardiology Hospital for Sick Children, Toronto, Canada
Manuscript received January 23, 2003;
revised manuscript received June 8, 2003,
accepted June 23, 2003.
* Reprint requests and correspondence: Dr. Andrew N. Redington, Division of Cardiology, The Hospital for Sick Children, 555 University Avenue, Toronto M5G 1X8, Canada.
andrew.redington{at}sickkids.ca
OBJECTIVES: The aim of this study was to assess the utility of tissue Doppler echocardiography in the setting of repaired transposition of the great arteries when the right ventricle (RV) functions as the systemic ventricle.
BACKGROUND: Myocardial acceleration during isovolumic contraction, "isovolumic myocardial acceleration" (IVA), has been validated as a sensitive non-invasive method of assessing RV contractility. Although traditional indexes may be less valid for the abnormal RV, the relative insensitivity of IVA to an abnormal load makes it a potentially powerful clinical tool for the assessment of RV disease.
METHODS: We examined 55 controls and 80 patients (mean age 22 years) with transposition, who had undergone atrial repair at age 8 (0.3 to 72) months. A subgroup of 12 underwent cardiac catheterization. The RV systolic function was derived by analysis of pressure-volume relationships and IVA both at rest and during dobutamine stress. In all 80, myocardial velocities were sampled in the RV free wall.
RESULTS: During dobutamine (10 µg/kg/min for 10 min), the increase of IVA mirrored the increase in end-systolic elastance (r = 0.69, p < 0.02). In the group as a whole, IVA was reduced compared with the subpulmonary RV and the systemic left ventricle of controls. There was abnormal wall motion in 44 patients, which was associated with reduced IVA. Diastolic myocardial velocities were also abnormal but unrelated to the presence of wall motion abnormalities.
CONCLUSIONS: The IVA can accurately assess changes in RV contractile function in patients with an RV as the systemic ventricle. Global long-axis RV function is reduced in patients with transposition, and this is associated with abnormal regional function.
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Abbreviations and Acronyms
| | IVA | = isovolumic myocardial acceleration | | LV | = left ventricle/ventricular | | RV | = right ventricle/ventricular | | TDE | = tissue Doppler echocardiography | | TGA | = transposition of the great arteries |
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