[Echocardiographic manifestations of excessive pulmonary artery banding in patients with transposition of the great arteries without ductal or ventricular shunt].
Recently, pulmonary arterial banding (PAB) and the Blalock-Taussig shunting operation (B-T) have been performed as a preparatory procedure for Jatene's operation for patients with complete transposition of the great arteries (TGA) without patent ductus arteriosus (PDA) or ventricular septal defect (VSD). We reviewed the echocardiographic findings of 29 patients after PAB and B-T. Four cases had abnormal catheterization data after PAB and B-T (Group 1). Twenty-five control cases with successful two-stage Jatene's operation exhibited normal data (Group 2). We studied 1) the grade of distortion of the interventricular septum as the a/b ratio on two-dimensional echocardiogram (2-DE), 2) the left ventricular (LV) shortening fraction (LVSF), 3) the thickening fraction (ThF), 4) the LV posterior wall thickness in diastole (LVPWTd) on M-mode echocardiogram, and 5) the LV inflow tract (LVIT) flow pattern on pulsed Doppler echocardiogram. In Group 1, all cases revealed LVSF less than 0.19 (control group: 0.40-0.56), ThF less than 0.18 (control group: 0.43-0.81), the a/b ratio higher than 0.88 (control group: 0.53-0.79), and LVPWTd thicker than 0.67 cm (control group: 0.45-0.59 cm). These data are markedly deviated from the range of the control data (p < 0.01). All cases in Group 1 had LVIT flow lacking the rapid filling phase, which was recognized in the control group. These abnormal echocardiographic findings suggest LV failure in adaptation against excessive after-load due to very tight PAB, and these figures are very different from the control group. These unusual postoperative cardiac abnormalities can be detected noninvasively using 2-DE and Doppler echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)
Katayama
H
H
Department of Pediatric Cardiology, Tokyo Women's Medical College.
Satomi
G
G
Takao
A
A
Kanda
S
S
Aotsuka
H
H
Yajima
S
S
D004452:Echocardiography; D006801:Humans; D007223:Infant; D011651:Pulmonary Artery / Q000601:surgery*; D014188:Transposition of Great Vessels / Q000601:surgery*