title: Effects of morphologic left ventricular pressure on right ventricular geometry and tricuspid valve regurgitation in patients with congenitally corrected transposition of the great arteries.
abstract: Congenitally corrected transposition of the great arteries (CCTGA) is associated with tricuspid regurgitation (TR), which has been postulated to arise from the effect of ventricular septal position on the attachments of the tricuspid valve. This study was performed to determine the effect of left ventricular (LV) pressure on right ventricular (RV) and LV geometry and the degree of TR. Serial echocardiograms were reviewed from, 30 patients with CCTGA who underwent pulmonary artery banding to train the morphologic left ventricle (n = 14) or left ventricle-to-pulmonary artery conduit placement and ventricular septal defect closure in conjunction with physiologic repair (n = 16). The degree of TR, the LV/RV pressure ratio, RV and LV sphericity indexes, and tricuspid valve tethering distance and coaptation length were analyzed. After pulmonary artery banding, an increase in LV systolic pressure to > or =2/3 systemic resulted in a decrease in TR from severe to moderate (p = 0.02). The percentage of patients with severe TR decreased from 64% to 18% (p = 0.06). The RV sphericity index decreased (p = 0.05), and the LV sphericity index increased (p = 0.02). After left ventricle-to-pulmonary artery conduit placement, a decrease in LV pressure to < or =1/2 systemic resulted in an increase in TR from none to mild (p = 0.003). In conclusion, these data indicate that LV pressure in patients with CCTGA affects the degree of TR and that septal shift caused by changes in LV and RV pressure is an important mechanism.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: Catharine A
authors.initials: CA
authors.lastname: Kral Kollars
authors.forename: Sarah
authors.initials: S
authors.lastname: Gelehrter
authors.forename: Edward L
authors.initials: EL
authors.lastname: Bove
authors.forename: Gregory
authors.initials: G
authors.lastname: Ensing
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006325:Heart Atria / Q000473:pathology; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011651:Pulmonary Artery / Q000601:surgery; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D017725:Ventricular Pressure / Q000502:physiology*