[Is the right ventricle able to maintain the systemic circulation for a long time? The late results of the Senning operation for complete transposition of the great arteries].
The successful surgical management of congenital heart defects increased the number of such a type of defects, in which the morphological right ventricle has to provide the systemic circulation. Children with transposition of the great arteries operated with Senning procedure are good examples to investigate the long-term right ventricular function. Aim of our study was to determine the adequate non-invasive methods to assess the progression of the right ventricular dysfunction, to analyse the long-term surgical results and to determine the indication of reoperation.


METHODS
Physical examination, electrocardiogram, 24 hours ECG, stress-testing, echocardiography, B-natriuretic peptide level measurement and magnetic resonance imagine were performed.


METHODS
176 Senning operations were carried out between 1980 and 1997. The follow-up period was 9-25 (mean 12.5) years and 83 children were included in our study.


RESULTS
Significant correlations were found between the MRI RVEF, and echocardiographic TEI index, TDI and BNP results. Abnormal values were found in Senning patients compared to healthy children in MRI RVEF 55%, echocardiographic TEI index 0.33, in RV TDI systolic velocities 0.2 m/s, and B-natriuretic peptide levels 150 pg/ml. That means that right ventricular disfunction is expected in Senning children even without clinical symptoms.


CONCLUSIONS
(1) BNP and echocardiographic TEI and TDI became available methods for the follow-up of right ventricular disfunction, and annual MRI is recommended. (2) Conversion of Senning to anatomic repair is considerable in selected young patients because the capacity of myocardium to respond to pressure overload decreasing with age. In older children and adults very close follow-up is necessary using biomarkers, echocardiography and MRI to decide the correct time of heart transplantation.
Hartyánszky
István
I
Gottsegen György Országos Kardiológiai Intézet, Budapest. hartyanszky@hotmail.com
Kádár
Krisztina
K
Oprea
Valéria
V
Lozsádi
Károly
K
Szabolcs
Judit
J
Szatmári
András
A
D006348:Cardiac Surgical Procedures / Q000379:methods*; D002675:Child, Preschool; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D013318:Stroke Volume; D014188:Transposition of Great Vessels / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology*; D016278:Ventricular Function, Right