title: Peripheral Endothelial Function After Arterial Switch Operation for D-looped Transposition of the Great Arteries.
abstract: Coronary artery re-implantation during arterial switch operation in patients with D-looped transposition of the great arteries (D-TGA) can alter coronary arterial flow and increase shear stress, leading to local endothelial dysfunction, although prior studies have conflicting results. Endothelial pulse amplitude testing can predict coronary endothelial dysfunction by peripheral arterial testing. This study tested if, compared to healthy controls, patients with D-TGA after arterial switch operation had peripheral endothelial dysfunction. Patient inclusion criteria were (1) D-TGA after neonatal arterial switch operation; (2) age 9-29 years; (3) absence of known cardiovascular risk factors such as hypertension, diabetes, hypercholesterolemia, vascular disease, recurrent vasovagal syncope, and coronary artery disease; and (4) ability to comply with overnight fasting. Exclusion criteria included (1) body mass index ≥85th percentile, (2) use of medications affecting vascular tone, or (3) acute illness. We assessed endothelial function by endothelial pulse amplitude testing and compared the results to our previously published data in healthy controls (n = 57). We tested 20 D-TGA patients (16.4 ± 4.8 years old) who have undergone arterial switch operation at a median age of 5 days (0-61 days). Endothelial pulse amplitude testing indices were similar between patients with D-TGA and controls (1.78 ± 0.61 vs. 1.73 ± 0.54, p = 0.73).In our study population of children and young adults, there was no evidence of peripheral endothelial dysfunction in patients with D-TGA who have undergone arterial switch operation. Our results support the theory that coronary arterial wall thickening and abnormal vasodilation reported in these patients is a localized phenomenon and not reflective of overall atherosclerotic burden.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Rady Children's Hospital, University of California, San Diego, 3020 Children's Way, San Diego, CA, 92123, USA.
authors.forename: Heather Y
authors.initials: HY
authors.lastname: Sun
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Palo Alto, CA, 94306, USA.
authors.forename: Katie Jo
authors.initials: KJ
authors.lastname: Stauffer
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Palo Alto, CA, 94306, USA.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Nourse
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Palo Alto, CA, 94306, USA.
authors.forename: Chau
authors.initials: C
authors.lastname: Vu
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Palo Alto, CA, 94306, USA. tierneys@stanford.edu.
authors.forename: Elif Seda
authors.initials: ES
authors.lastname: Selamet Tierney
mesh_terms: D000293:Adolescent; D000069278:Arterial Switch Operation / Q000009:adverse effects*; D002648:Child; D003324:Coronary Artery Disease / Q000209:etiology / Q000503:physiopathology*; D003331:Coronary Vessels / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000503:physiopathology*; D006801:Humans; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D014188:Transposition of Great Vessels / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
keywords: Arterial switch operation; Coronary arteries; Endothelial function; Vascular health