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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

View larger version (167K): [in a new window]   Figure 1 Tissue Doppler echocardiography spectral curve from a 21-year-old man with transposition of the great arteries after a Mustard operation. There is no detectable myocardial velocity during atrial contraction (A wave) related to the P wave on the electrocardiogram. The isovolumic myocardial acceleration is calculated as the difference between baseline and peak velocity (stars) during isovolumic contraction divided by their time interval.

View larger version (118K): [in a new window]   Figure 2 Normal myocardial velocity profile of the right ventricular (RV) free wall in a 17-year-old boy with transposition of the great arteries after a Senning operation. The systolic and diastolic velocities do not change direction when sampled from base to apex along the RV free wall. The tissue tracking software that integrates velocities directed from base to apex shows that there is myocardial displacement from base to apex during systole in all parts of the RV free wall.

View larger version (20K): [in a new window]   Figure 3 Correlation curve between isovolumic myocardial acceleration (IVA) and end-systolic elastance (Ees) during dobutamine stress in 12 patients with transposition of the great arteries.

View larger version (136K): [in a new window]   Figure 4 Tissue Doppler trace and tissue tracking in the free wall of the right ventricular (RV) in a 24-year-old man after a Mustard operation. There is a wall motion abnormality: tissue tracking demonstrates that during systole only the base and part of the midwall of the RV are displaced from base to apex (i.e., shorten) during systole, while the rest of the RV wall shortens in diastole. Likewise, the myocardial velocities in systole and diastole at the base (yellow) and apex (green) are reversed.