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. 1997 Oct;78(4):376–381. doi: 10.1136/hrt.78.4.376

Long term ventricular performance after intra-atrial correction of transposition: left ventricular filling is the major limitation

O Reich 1, C Ruth 1, J Marek 1
PMCID: PMC1892271  PMID: 9404254

Abstract

Objective—To establish the incidence of systolic and diastolic dysfunction of the right and left ventricle in a large cohort of patients after Mustard or Senning operations and to assess changes in the incidence on long term follow up.
Design—Postoperative case-control study using radionuclide ventriculography. Ejection fractions, peak filling rates, rapid filling periods and fractions, slow filling periods and fractions, and atrial contraction periods and fractions were studied.
Setting—Tertiary care centre, ambulatory and hospital inpatient care.
Patients—A convenience sample of 153 patients studied at median age of 6.9 years (median 4.4 years after surgery). In 99 cases another study was available at a median age of 15.3 years (median 13 years after surgery and 8.8 years after the first study).
Results—Respective incidences of dysfunction in the first and the second study were as follows: ejection fraction-right ventricle 7.8% and 8.1%, left ventricle 7.2% and 10.1%; peak filling rate-right ventricle 0% and 4.2%, left ventricle 14.3% and 29.5% (p < 0.05); rapid filling period- right ventricle 18.3% and 11.6%, left ventricle 30.2% and 30.5%; slow filling period—right ventricle 4.8% and 3.2%; left ventricle 11.9% and 23.2%; atrial contraction period-right ventricle 0.8% and 4.2%, left ventricle 15.1% and 26.3%; rapid filling fraction-right ventricle both 0%, left ventricle 82.5% and 79.0%; slow filling fraction-right ventricle 0.8% and 4.2%, left ventricle 37.3% and 30.5%; atrial contraction fraction-right ventricle both 0%, left ventricle 79.4% and 71.6%.
Conclusions—The incidence of systolic ventricular dysfunction is 8% (right ventricle) and 10% (left ventricle) 13 years after surgery, without a significant increase over the eight year follow up. Diastolic filling is abnormal in up to 80% of patients and left ventricular peak filling rate deteriorates with time.

 Keywords: congenital heart defects;  transposition of the great arteries;  radionuclide ventriculography;  ventricular function

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Figure 1  .

Figure 1  

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Calculation of the variables (see text). ACF, atrial contraction fraction; ACP, atrial contraction period; DV, change in velocity; EDV, end diastolic volume; ESV, end systolic volume; RFF, rapid filling fraction; RFP, rapid filling period; SFF, slow filling fraction; SFP, slow filling period; SV, stroke volume.

Figure 2  .

Figure 2  

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Comparison of volume curves before and early after the surgery. Note changes in the left ventricular diastolic filling. TGA, transposition of the great arteries; Mustard, Mustard operation.

Figure 3  .

Figure 3  

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Actuarial probability of normal values. LVEF, left ventricular ejection fraction; LVPFR, left ventricular peak filling rate; LVRFF, left ventricular rapid filling fraction; RVEF, right ventricular ejection fraction.

Figure 4  .

Figure 4  

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M mode (left panel) and pulsed Doppler (right panel) findings after Senning procedure. In mid-diastole (arrows), the systemic venous atrium (SVA) is compressed by pressure from surrounding pulmonary venous atrium (PVA). This causes a decrease in left ventricular filling rate until the SVA reopens due to a pressure increase proximal to the narrowed segment. The filling rate then increases again, with only a small contribution from atrial contraction (arrowhead). See Discussion.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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