title: Left and right ventricular performance after arterial switch operation.
abstract: OBJECTIVE
  Recent descriptions of decreased exercise capacity 10 to 15 years after arterial switch operation (ASO) suggest subclinical hemodynamic restrictions. Persistent impairment of ventricular performance following ASO may add to this. We aimed to characterize the time course of changes in biventricular performance within the first year following ASO.
  
  
  METHODS
  We prospectively included 26 patients with transposition of the great arteries undergoing ASO and 20 age-matched controls. Left and right ventricular systolic and diastolic performance was assessed using tissue Doppler imaging-derived peak systolic velocity, peak diastolic velocity, and peak early wave Doppler flow velocity/early diastolic tissue Doppler imaging velocity as well as mitral and tricuspid annular plane systolic excursion. Furthermore, left ventricular longitudinal, radial, and circumferential strain were assessed using speckle tracking strain imaging. Studies were performed preoperatively, 1 day postoperatively, at discharge, and at medium-term follow-up (9 months [interquartile range, 6-23 months] postoperatively).
  
  
  RESULTS
  After an initial decrease in biventricular systolic and diastolic performance 1 day postoperatively versus preoperatively, recovery was observed in all parameters during medium-term follow-up. At medium-term follow-up left ventricular systolic and diastolic performance parameters were comparable in patients and controls. In contrast, right ventricular systolic and diastolic performance were still impaired in patients versus controls roughly 1 year postoperatively (tricuspid annular plane systolic excursion, 11.6 ± 2.2 vs 18.6 ± 3.1 mm; right ventricular peak systolic velocity, 8.1 ± 2.3 vs 12.6 ± 1.8 cm/second; right ventricular peak diastolic velocity, 12.4 ± 3.0 vs 18.2 ± 4.2 cm/second; and right ventricular peak early wave Doppler flow velocity/early diastolic tissue Doppler imaging velocity, 6.7 ± 2.1 vs 4.3 ± 1.3; all Ps < .001).
  
  
  CONCLUSIONS
  If early ASO is performed, left ventricular performance recovers to control values within the first postoperative year. In contrast, right ventricular systolic and diastolic performance remained impaired during follow-up, which stresses the importance of postoperative follow-up of right ventricular performance.
authors.affiliation: Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Liselotte M
authors.initials: LM
authors.lastname: Klitsie
authors.affiliation: Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Arno A W
authors.initials: AA
authors.lastname: Roest
authors.affiliation: Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Irene M
authors.initials: IM
authors.lastname: Kuipers
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Hazekamp
authors.affiliation: Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Nico A
authors.initials: NA
authors.lastname: Blom
authors.affiliation: Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: A.D.J.Ten_Harkel@lumc.nl.
authors.forename: Arend D J
authors.initials: AD
authors.lastname: Ten Harkel
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D016022:Case-Control Studies; D002648:Child; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011446:Prospective Studies; D020127:Recovery of Function; D013599:Systole; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right