title: A case series of systemic right ventricular dysfunction post atrial switch for simple D-transposition of the great arteries: the impact of beta-blockade.
abstract: 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.
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Canada.
authors.forename: Colin B
authors.initials: CB
authors.lastname: Josephson
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Howlett
authors.forename: Simon D
authors.initials: SD
authors.lastname: Jackson
authors.forename: John
authors.initials: J
authors.lastname: Finley
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Kells
mesh_terms: 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
chemical_list: D000319:Adrenergic beta-Antagonists