The systemic right ventricle in congenitally corrected transposition of the great arteries is different from the right ventricle in dextro-transposition after atrial switch: a cardiac magnetic resonance study.
BACKGROUND
Patients with a congenitally corrected transposition of the great arteries show an increasing incidence of cardiac failure with age. In other systemic right ventricles, such as in dextro-transposition after atrial switch, excessive hypertrophy is a potential risk factor for impaired systolic function. In this trial, we sought to compare systemic function and volumes between patients with congenitally corrected transposition and those with dextro-transposition after atrial switch by using cardiac magnetic resonance imaging.


RESULTS
A total of 19 patients (nine male) with congenitally corrected transposition and 31 patients (21 male) with dextro-transposition after atrial switch were studied using a 1.5-Tesla scanner. Cine steady-state free-precession sequences in standard orientations were acquired for volumetric and functional imaging. Patient parameters were compared with those of a group of 25 healthy volunteers. Although patients with congenitally corrected transposition were older, they presented with higher right ventricular ejection fractions (p = 0.04) compared with patients with dextro-transposition. Patients with congenitally corrected transposition showed a weak negative correlation between age at examination and systemic ejection fraction (r = −0.18, p = 0.04) but no correlation between right ventricular myocardial mass index and ejection fraction. There was no significant difference in the right ventricular end-diastolic volumes between both patient groups.


CONCLUSIONS
Although patients with congenitally corrected transposition had a longer pressure load of the systemic right ventricle, ventricular function was better compared with that in patients with dextro-transposition after atrial switch. The results suggest that the systemic ventricles might have partly different physiologies. One difference could be the post-operative situation after atrial switch, which results in impaired atrial contribution to ventricular filling.
Department of Diagnostic and Interventional Radiology, University of Leipzig-Heart Center, Struempellstrasse 39, Leipzig, Germany. grothoff@gmx.de
Matthias
M
Grothoff
Antje
A
Fleischer
Hashim
H
Abdul-Khaliq
Janine
J
Hoffmann
Lukas
L
Lehmkuhl
Christian
C
Luecke
Matthias
M
Gutberlet
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D000080041:Congenitally Corrected Transposition of the Great Arteries; D005260:Female; D006325:Heart Atria / Q000601:surgery; D006333:Heart Failure / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D014188:Transposition of Great Vessels / Q000150:complications / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D055815:Young Adult