Gothic aortic arch and cardiac mechanics in young patients after arterial switch operation for d-transposition of the great arteries.
BACKGROUND
In patients who have undergone arterial switch operation (ASO) for d-transposition of the great arteries a gothic aortic arch (GA) morphology has been found and it has been associated with abnormal aortic bio-elastic properties.


OBJECTIVE
GA is frequent in ASO patients and may have an impact on cardiac mechanics. Our study aims were to assess 1- the occurrence of GA in a large sample of patients after ASO; 2- the association between GA and aortic bio-elastic properties; and 3- the impact of GA on left ventricular (LV) function using speckle tracking echocardiography (STE).


METHODS
We studied one hundred and five asymptomatic patients, who have undergone first stage ASO for d-TGA, with normal left ventricular ejection fraction (LVEF ≥53%).


RESULTS
Forty-six (44%) patients showed a GA (mean age 11.5±7.2years, 26 males) while fifty-nine (56%) patients (mean age 9.6±6.7years, 37 males) did not present GA. The two groups were comparable for age, sex, BSA, and office blood pressure values. In group GA aortic root was significantly dilated (27.4±7.5mm vs. 21.2±6.9mm, p<0.0001), aortic stiffness index (Group GA=1.8±1.2 vs. 1.4±0.7, p=0.025) was significantly increased, left atrial volume was larger (p=0.0145), global longitudinal strain (Group GA=-18.4±2.5% vs. -20.1±3.3%, p=0.012) and basal LV longitudinal strains (Group GA=-16.9±4.8% vs. -20.4±7.0%, p=0.013) were significantly reduced.


CONCLUSIONS
After ASO the presence of a GA is associated with a significantly dilated aortic root, stiffer aortic wall, larger left atrial volume, and worse LV longitudinal systolic deformations, well known predictors of cardiovascular morbidity and mortality.
King Faisal Specialist Hospital and Research Centre, Al Faisal University, Heart Center, Riyadh, Saudi Arabia. Electronic address: giodisal@yahoo.it.
Giovanni
G
Di Salvo
King Faisal Specialist Hospital and Research Centre, Al Faisal University, Heart Center, Riyadh, Saudi Arabia; American University of Beirut, Pediatric Cardiology, Beirut, Lebanon.
Ziad
Z
Bulbul
King Faisal Specialist Hospital and Research Centre, Al Faisal University, Heart Center, Riyadh, Saudi Arabia.
Valeria
V
Pergola
King Faisal Specialist Hospital and Research Centre, Al Faisal University, Heart Center, Riyadh, Saudi Arabia.
Ziad
Z
Issa
King Faisal Specialist Hospital and Research Centre, Al Faisal University, Heart Center, Riyadh, Saudi Arabia.
Ghassan
G
Siblini
King Faisal Specialist Hospital and Research Centre, Al Faisal University, Heart Center, Riyadh, Saudi Arabia.
Nisreen
N
Muhanna
King Faisal Specialist Hospital and Research Centre, Al Faisal University, Heart Center, Riyadh, Saudi Arabia.
Domenico
D
Galzerano
King Faisal Specialist Hospital and Research Centre, Al Faisal University, Heart Center, Riyadh, Saudi Arabia.
Bahaa
B
Fadel
King Faisal Specialist Hospital and Research Centre, Al Faisal University, Heart Center, Riyadh, Saudi Arabia.
Mansour
M
Al Joufan
King Faisal Specialist Hospital and Research Centre, Al Faisal University, Heart Center, Riyadh, Saudi Arabia.
Majid
M
Al Fayyadh
King Faisal Specialist Hospital and Research Centre, Al Faisal University, Heart Center, Riyadh, Saudi Arabia.
Zohair
Z
Al Halees
D000293:Adolescent; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging* / Q000601:surgery*; D000069278:Arterial Switch Operation / Q000009:adverse effects / Q000639:trends*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
Aortic arch morphology; Arterial switch operation; Speckle tracking echocardiography