Hornung A, Vollmer D, Wiegand G, Apitz C, Latus H, Hofbeck M, Sieverding L. A Comprehensive Functional Analysis in Patients after Atrial Switch Surgery.
Thorac Cardiovasc Surg 2021;
69:e32-e40. [PMID:
33851400 PMCID:
PMC8045928 DOI:
10.1055/s-0041-1726307]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Long-term course after atrial switch operation is determined by
increasing right ventricular (RV) insufficiency. The aim of our study was to investigate
subtle functional parameters by invasive measurements with conductance technique and
noninvasive examinations with cardiac magnetic resonance imaging (CMR).
Methods We used invasive (pressure–volume loops under baseline conditions and
dobutamine) and noninvasive techniques (CMR with feature tracking [FT] method) to evaluate
RV function. All patients had cardiopulmonary exercise testing (CPET).
Results From 2011 to 2013, 16 patients aged 28.2 ± 7.3 (22–50) years after atrial
switch surgery (87.5% Senning and 12.5% Mustard) were enrolled in this prospective study.
All patients were in New York Heart Association (NYHA) class I to II and presented mean
peak oxygen consumption of 30.1 ± 5.7 (22.7–45.5) mL/kg/min. CMR-derived end-diastolic
volume was 110 ± 22 (78–156) mL/m 2 and RV ejection fraction 41 ± 8% (25–52%).
CMR-FT revealed lower global systolic longitudinal, radial, and circumferential strain for
the systemic RV compared with the subpulmonary left ventricle. End-systolic elastance
(Ees) was overall reduced (compared with data from the literature) and showed significant
increase under dobutamine (0.80 ± 0.44 to 1.89 ± 0.72 mm Hg/mL, p ≤ 0.001), whereas
end-diastolic elastance (Eed) was not significantly influenced (0.11 ± 0.70 to
0.13 ± 0.15 mm Hg/mL, p = 0.454). We found no relevant relationship between
load-independent conductance indices and strain or CPET parameters. Conductance analysis
revealed significant mechanical dyssynchrony, higher during diastole (mean 30 ± 4%
baseline, 24 ± 6% dobutamine) than during systole (mean 17 ± 6% baseline, 19 ± 7%
dobutamine).
Conclusions Functional assessment of a deteriorating systemic RV remains
demanding. Conductance indices as well as the CMR-derived strain parameters showed overall
reduced values, but a significant relationship was not present (including CPET). Our
conductance analysis revealed intraventricular and predominantly diastolic RV
dyssynchrony.
Collapse