A case series of systemic right ventricular dysfunction post atrial switch for simple D-transposition of the great arteries: the impact of beta-blockade.
BACKGROUND
Patients with atrial switch (Mustard or Senning) repair of D-transposition of the great arteries (D-TGA) are at increased risk for atrial arrhythmias, systemic right ventricular (RV) dysfunction and late mortality.


OBJECTIVE
To evaluate case series from a single-centre experience with beta-blocker use in adult, post atrial switch, simple D-TGA patients.


METHODS
The Adult Congenital Heart Disease Clinic (Halifax, Nova Scotia) database was used to identify patients with post atrial switch, simple D-TGA. Treatment effect of beta-blockade was evaluated.


RESULTS
Eight patients were treated with beta-blockers for systemic RV dysfunction (n=2), arrhythmia (n=2) or both (n=4). Median follow-up was three years, at which time seven of eight patients were still on beta-blockade. Of those patients with complete data, two of five had improved systemic ventricular dysfunction, two of four had improved tricuspid regurgitation and four of six had improved functional capacity, as determined by history or exercise testing. Beta-blockade was well tolerated in seven of eight patients without any significant clinical deterioration.


CONCLUSIONS
Beta-blockade was used infrequently in patients with a prior Mustard procedure. When beta-blockade was prescribed to patients with a prior atrial switch procedure, the drugs were well tolerated and were associated with trends toward improved symptoms, less tricuspid regurgitation and improved functional status in patients with reduced systemic RV function. These data support the need for a randomized trial of beta-blockade in patients with a previous Mustard or Senning operation and RV dysfunction.
Josephson
Colin B
CB
Department of Medicine, Dalhousie University, Halifax, Canada.
Howlett
Jonathan G
JG
Jackson
Simon D
SD
Finley
John
J
Kells
Catherine M
CM
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D009200:Myocardial Contraction / Q000187:drug effects; D011184:Postoperative Period; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000601:surgery*; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology
D000319:Adrenergic beta-Antagonists