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Engele LJ, van der Palen RLF, Egorova AD, Bartelings MM, Wisse LJ, Glashan CA, Kiès P, Vliegen HW, Hazekamp MG, Mulder BJM, Ruiter MCD, Bouma BJ, Jongbloed MRM. Cardiac Fibrosis and Innervation State in Uncorrected and Corrected Transposition of the Great Arteries: A Postmortem Histological Analysis and Systematic Review. J Cardiovasc Dev Dis 2023; 10:jcdd10040180. [PMID: 37103059 PMCID: PMC10143292 DOI: 10.3390/jcdd10040180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/28/2023] Open
Abstract
In the transposition of the great arteries (TGA), alterations in hemodynamics and oxygen saturation could result in fibrotic remodeling, but histological studies are scarce. We aimed to investigate fibrosis and innervation state in the full spectrum of TGA and correlate findings to clinical literature. Twenty-two human postmortem TGA hearts, including TGA without surgical correction (n = 8), after Mustard/Senning (n = 6), and arterial switch operation (ASO, n = 8), were studied. In newborn uncorrected TGA specimens (1 day-1.5 months), significantly more interstitial fibrosis (8.6% ± 3.0) was observed compared to control hearts (5.4% ± 0.8, p = 0.016). After the Mustard/Senning procedure, the amount of interstitial fibrosis was significantly higher (19.8% ± 5.1, p = 0.002), remarkably more in the subpulmonary left ventricle (LV) than in the systemic right ventricle (RV). In TGA-ASO, an increased amount of fibrosis was found in one adult specimen. The amount of innervation was diminished from 3 days after ASO (0.034% ± 0.017) compared to uncorrected TGA (0.082% ± 0.026, p = 0.036). In conclusion, in these selected postmortem TGA specimens, diffuse interstitial fibrosis was already present in newborn hearts, suggesting that altered oxygen saturations may already impact myocardial structure in the fetal phase. TGA-Mustard/Senning specimens showed diffuse myocardial fibrosis in the systemic RV and, remarkably, in the LV. Post-ASO, decreased uptake of nerve staining was observed, implicating (partial) myocardial denervation after ASO.
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Affiliation(s)
- Leo J Engele
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Centre, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Netherlands Heart Institute, 3511 EP Utrecht, The Netherlands
| | - Roel L F van der Palen
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Pediatric Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Anastasia D Egorova
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Margot M Bartelings
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Anatomy and Embryology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Lambertus J Wisse
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Anatomy and Embryology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Claire A Glashan
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Philippine Kiès
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Hubert W Vliegen
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Mark G Hazekamp
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Cardiothoracic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Barbara J M Mulder
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Centre, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Marco C De Ruiter
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Anatomy and Embryology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Berto J Bouma
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Centre, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Monique R M Jongbloed
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Department of Anatomy and Embryology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Poerner TC, Goebel B, Figulla HR, Ulmer HE, Gorenflo M, Borggrefe M, Arnold R. Diastolic biventricular impairment at long-term follow-up after atrial switch operation for complete transposition of the great arteries: an exercise tissue Doppler echocardiography study. J Am Soc Echocardiogr 2007; 20:1285-93. [PMID: 17604961 DOI: 10.1016/j.echo.2007.03.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate regional myocardial function after atrial switch operation for transposition of the great arteries (TGA) using tissue Doppler echocardiography with strain rate (SR) imaging. METHODS In all, 24 patients with TGA aged 12 to 33 years and 10 control subjects underwent tissue Doppler echocardiography/SR imaging at rest and during bicycle exercise at 1 and 2 W/kg. Longitudinal function was quantified by strain, SR, and peak velocities measured in the free wall of the systemic ventricle, in septum and in the lateral wall of the subpulmonary ventricle. RESULTS In patients with TGA, both ventricles showed reduced peak systolic SR values at rest. The increase in peak early diastolic velocity with exercise was reduced in the systemic ventricle (-47 +/- 23 mm/s at rest to -73 +/- 35 mm/s at 2 W/kg, P < .05) and absent in the subpulmonary ventricle (-78 +/- 38 mm/s at rest to -75 +/- 19 mm/s at 2 W/kg) of patients with TGA. CONCLUSION Exercise tissue Doppler echocardiography/SR imaging identified severely reduced relaxation reserve of both ventricles as typical feature of myocardial dysfunction after atrial repair for TGA.
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Affiliation(s)
- Tudor C Poerner
- First Department of Medicine, University Hospital of Jena, Jena, Germany.
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Vida VL, Angelini A, Ausoni S, Bilardi A, Ori C, Vlassich F, Zoso V, Milanesi O, Sartore S, della Barbera M, Zaglia T, Thiene G, Stellin G. Age is a risk factor for maladaptive changes in rats exposed to increased pressure loading of the right ventricular myocardium. Cardiol Young 2007; 17:202-11. [PMID: 17381884 DOI: 10.1017/s1047951107000376] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2006] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To study the adaptive potential of the right ventricular myocardium after 30 days of mechanical-induced overload in rats from two different age groups. MATERIALS AND METHODS We banded the pulmonary trunk, so as to increase the systolic work load of the right ventricle, in 19 adult Sprague-Dawley rats at the age of 10 weeks, and 16 weanlings when they were 3 weeks-old, using 10 adults and 10 weanlings as controls. We analysed the functional adaptation and structural changes of the right ventricular myocardium, blood vessels and interstitial tissue after 30 days of increased afterload. RESULTS The increased workload induced an increase of the right ventricular weight and free wall thickness in animals from both age groups when compared to controls. These changes were mostly related to cardiomyocytic hypertrophy, as confirmed by the expression of myocardial hypertrophic markers, without any apparent increase of their number, a "reactive" fibrosis especially evident in the adult rats, with p-value less than 0.0001, and a more extensive neocapillary network in the weanlings compared to the adults aubsequent to banding, the p-value being less than 0.0001. CONCLUSION In response to right ventricular afterload, weanlings showed a higher adaptive capillary growth, which hampered the development of fibrosis as seen in the adult rats. Age seems to be a risk factor for adverse structural-functional changes of right ventricle subjected to increased workload.
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Affiliation(s)
- Vladimiro L Vida
- Department of Pediatric Cardiac Surgery, University of Padua, Padua, Italy.
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