Published Online
on August 23, 2004

A more recent version of this article appeared on September 14, 2004

This Article Full Text (PDF) All Versions of this Article: 110/11/1380    most recent 01.CIR.0000141370.18560.D1v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Li, W. Articles by Henein, M. Search for Related Content PubMed PubMed Citation Articles by Li, W. Articles by Henein, M. Related Collections Exercise/exercise testing/rehabilitation Echocardiography Pediatric and congenital heart disease, including cardiovascular surgery Other Research

Submitted on February 27, 2003
Revised on April 22, 2004
Accepted on April 26, 2004

Relation of Biventricular Function Quantified by Stress Echocardiography to Cardiopulmonary Exercise Capacity in Adults With Mustard (Atrial Switch) Procedure for Transposition of the Great Arteries

Wei Li MD, PhD, Tim S. Hornung MD, Darrel P. Francis MRCP, Christine O’Sullivan BSc, Alison Duncan MRCP, Michael Gatzoulis MD, PhD, and Michael Henein MD, PhD^*

From Royal Brompton Hospital and Imperial College School of Medicine, London, United Kingdom.

^* To whom correspondence should be addressed. E-mail: m.henein{at}rbh.nthames.nhs.uk.

Background--Mustard repair for transposition of the great arteries (TGA) is frequently associated with impaired systemic (right) ventricular function and sometimes exercise intolerance. We hypothesized that a simple quantitative measurement of ventricular function, during rest and pharmacological stress, could identify abnormalities and predict objective exercise capacity.

Methods and Results--We quantified the performance of systemic and pulmonary (left) ventricles by using echocardiography, at rest and during dobutamine stress, in 27 adults who had undergone Mustard repair for TGA. Systolic and diastolic function of the systemic ventricle were markedly disturbed with respect to pulmonary ventricular function. We also measured exercise capacity by cardiopulmonary exercise testing for peak oxygen uptake. Exercise capacity was significantly predicted by systemic ventricular long-axis excursion both at rest (r=0.66, P<0.001) and at peak dobutamine stress (r=0.53, P=0.006) but not by pulmonary ventricular long-axis excursion at rest (r=0.04) or on stress (r=0.11). Exercise capacity was also predicted by the septal long-axis excursion at rest (r=0.61, P=0.001) but not pulmonary ventricular free wall excursion (P>0.05) or fractional shortening (P>0.05). Peak aortic velocity at maximum dobutamine stress correlated with exercise capacity (r=0.46, P=0.029) but not at rest (r=0.36). Multivariate analysis revealed systemic ventricular long-axis excursion to be the sole significant independent predictor of exercise capacity.

Conclusions--Systemic ventricular function is depressed in most patients with Mustard repair. Quantitative echocardiographic evaluation shows systemic ventricular function to be a key determinant of exercise capacity.

Key words: transposition of great vessels • echocardiography • exercise

This article has been cited by other articles:

				H. S. Yang, F. Mookadam, T. A. Warsame, B. K. Khandheria, J. A. Tajik, and K. Chandrasekaran Evaluation of right ventricular global and regional function during stress echocardiography using novel velocity vector imaging Eur J Echocardiogr, November 28, 2009; (2009) jep190v1. [Abstract] [Full Text] [PDF]

				K. Takahashi, A. Inage, I.M. Rebeyka, D.B. Ross, R.B. Thompson, A.S. Mackie, and J.F. Smallhorn Real-Time 3-Dimensional Echocardiography Provides New Insight Into Mechanisms of Tricuspid Valve Regurgitation in Patients With Hypoplastic Left Heart Syndrome Circulation, September 22, 2009; 120(12): 1091 - 1098. [Abstract] [Full Text] [PDF]

				A. A. Frogoudaki Assessing the Failing Systemic Right Ventricle Angiology, August 1, 2008; 59(2_suppl): 93S - 96S. [Abstract] [PDF]

				A. Uebing, D. G. Gibson, S. V. Babu-Narayan, G. P. Diller, K. Dimopoulos, O. Goktekin, M. S. Spence, K. Andersen, M. Y. Henein, M. A. Gatzoulis, et al. Right Ventricular Mechanics and QRS Duration in Patients With Repaired Tetralogy of Fallot: Implications of Infundibular Disease Circulation, October 2, 2007; 116(14): 1532 - 1539. [Abstract] [Full Text] [PDF]

				G.-P. Diller, D. Okonko, A. Uebing, S. Y. Ho, and M. A. Gatzoulis Cardiac resynchronization therapy for adult congenital heart disease patients with a systemic right ventricle: analysis of feasibility and review of early experience. Europace, April 1, 2006; 8(4): 267 - 272. [Abstract] [Full Text] [PDF]

				P A Davlouros, K Niwa, G Webb, and M A Gatzoulis The right ventricle in congenital heart disease Heart, April 1, 2006; 92(suppl_1): i27 - i38. [Abstract] [Full Text] [PDF]

				S. V. Babu-Narayan, O. Goktekin, J. C. Moon, C. S. Broberg, G. A. Pantely, D. J. Pennell, M. A. Gatzoulis, and P. J. Kilner Late Gadolinium Enhancement Cardiovascular Magnetic Resonance of the Systemic Right Ventricle in Adults With Previous Atrial Redirection Surgery for Transposition of the Great Arteries Circulation, April 26, 2005; 111(16): 2091 - 2098. [Abstract] [Full Text] [PDF]