Abstract 11149: Progressive Deterioration in Left Ventricular Deformation After Pulmonary Artery Band Training and Subsequent Repair in Ventriculoarterial Discordance
Background: In patients with ventriculoarterial discordance, such as d-transposition (d-TGA) and congenitally corrected transposition (cc-TGA) of the great arteries, the morphologic left ventricle (LV) becomes deconditioned when neonatal correction is not performed. In these cases, pulmonary artery band (PAB) placement increases LV afterload in an effort to prepare the LV for subsequent anatomic repair. Anatomic repair establishes ventriculoarterial concordance; however, significant LV dysfunction may still develop postoperatively. This study aims to characterize LV function longitudinally via strain analysis using speckle tracking in patients with ventriculoarterial discordance who underwent LV training and subsequent repair. Patients with d-TGA who underwent neonatal arterial switch operation (ASO) were evaluated perioperatively for comparison.
Methods: Twenty-nine PAB patients (12 d-TGA and 17 cc-TGA) and twenty ASO patients were evaluated. LV ejection fraction (EF), peak global and regional longitudinal strain (S) and strain rate (SR) were measured (excluding apical segments) before and after the following surgeries: 1) PAB, 2) subsequent anatomic repair, and 3) ASO (7 ± 5 days postoperatively overall).
Results: After PAB, LV EF and global S decreased from 76.1 ± 10.2% to 66.7 ± 7.8% (p < 0.001) and -17.7 ± 9% to -13.3 ± 7.5% (p = 0.01), respectively. After subsequent anatomic repair in the same group (median 22 months after PAB, range 0.5 - 104 months), LV EF and global S decreased further, from 63.7 ± 8.7% to 53.5 ± 14.7% (p = 0.03) and -17.7% ± 4.5 to -13 ± 3.8% (p < 0.01), respectively. In comparison, there was no significant change in LV EF, global S, or SR after neonatal ASO (p = 0.11 - 0.74).
Conclusion: In patients with ventriculoarterial discordance undergoing an LV training regimen with PAB placement and delayed anatomic repair, the LV demonstrates decremental systolic function as described by EF and global and regional left ventricular deformation.
- © 2011 by American Heart Association, Inc.