Tissue Doppler derived isovolumic acceleration in patients after atrial repair for dextrotransposition of the great arteries.
BACKGROUND
Ventricular dysfunction represents one of the major problems in the long-term follow-up of patients after atrial repair for dextrotransposition of the great arteries. We aimed to study the role of tissue Doppler derived isovolumic acceleration (IVA) to detect early myocardial dysfunction in these patients.


METHODS
Twenty-four patients with dextrotransposition of the great arteries (D-TGA) that underwent atrial repair (Senning procedure: n = 12; Mustard procedure: n = 12) in infancy were examined at the age of 21 [12-33] years (median [range]) using tissue Doppler analysis of IVA and peak systolic myocardial velocity at rest and during exercise. 12 age-matched healthy subjects served as controls.


RESULTS
At rest, IVA and peak systolic myocardial velocity were reduced in the systemic ventricle (SV) of patients. IVA correlated with peak systolic myocardial velocity (r = 0.76, P < 0.001). During exercise, IVA, but not peak systolic myocardial velocity, increased significantly in the SV of patients (rest: 1.03 +/- 0.44 cm/sec(2); 1 W/kg: 1.80 +/- 1.22 cm/sec(2); 2 W/kg: 2.85 +/- 1.26 cm/sec(2)). In the subpulmonary ventricle, IVA was significantly lower in patients compared to the controls (patients: 1.45 +/- 0.49 cm/sec(2) vs. controls: 2.31 +/- 0.43 cm/sec(2), P < 0.05). IVA but not peak systolic myocardial velocity was able to discriminate between patients and healthy subjects.


CONCLUSIONS
IVA is superior to peak systolic myocardial velocity to assess a reduction in functional reserve of both ventricles in patients after atrial repair for D-TGA.
Arnold
Raoul
R
Department of Pediatric Cardiology, University Hospital Freiburg, Freiburg, Germany. raoul.arnold@uniklinik-freiburg.de
Gorenflo
Matthias
M
Böttler
Petra
P
Eichhorn
Joachim
J
Jung
Christian
C
Goebel
Björn
B
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler / Q000379:methods*; D018618:Echocardiography, Doppler, Color; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology*; D012016:Reference Values; D015203:Reproducibility of Results; D018570:Risk Assessment; D012737:Sex Factors; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult