Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-27T23:07:54.406Z Has data issue: false hasContentIssue false
  • English
  • Français

Regional and global right ventricular dysfunction in asymptomatic or minimally symptomatic patients with congenitally corrected transposition

Published online by Cambridge University Press:  20 January 2005

Igor I. Tulevski ,
Frank M. Zijta ,
Anika S. Smeijers ,
Ali Dodge-Khatami ,
Ernst E. van der Wall  and
Barbara J. M. Mulder
Igor I. Tulevski
Affiliation:
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
Frank M. Zijta
Affiliation:
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
Anika S. Smeijers
Affiliation:
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
Ali Dodge-Khatami
Affiliation:
Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands
Ernst E. van der Wall
Affiliation:
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Barbara J. M. Mulder
Affiliation:
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
Get access Rights & Permissions [Opens in a new window]

Abstract

Patients with congenitally corrected transposition are at risk of right ventricular dysfunction and failure. With this in mind, we examined 13 patients with congenitally corrected transposition, 7 not having undergone surgery, and 6 after physiological repair, comparing them with 6 healthy subjects matched for age and sex, using cardiac magnetic resonance imaging, at rest and during dobutamine stress, in order to determine regional and global right ventricular response to stress.

At rest, the patients had significantly decreased overall wall motion compared to their healthy peers (7.2 ± 0.5, versus 9.8 ± 0.4 mm). During infusion of dobutamine, overall wall motion increased to 12.8 ± 0.4 mm in the healthy subjects, versus 8.8 ± 1.0 mm in patients. At the regional level, significant differences in mural motion were found between patients and controls in the anterior (9.5 ± 1.1, versus 13.2 ± 0.6 mm), posterior (10.2 ± 1.6, versus 13.2 ± 0.8 mm), and septal segments (5.0 ± 0.8, versus 11.2 ± 0.6 mm).

At rest, overall mural thickening in patients was similar to that of controls, but significantly less in patients during stress. During dobutamine stress, patients showed significantly less regional wall thickening than controls, particularly in the septal (2.7 ± 0.6, versus 6.0 ± 0.4 mm, respectively) and in the anterior segments (4.2 ± 0.6, versus 7.8 ± 0.6 mm, respectively). Right ventricular ejection fraction strongly correlated with mural motion and thickening, both at rest and during stress.

Abnormal regional function in the systemic morphologically right ventricle may occur in patients with congenitally corrected transposition, which strongly correlates with right ventricular ejection fraction. Our findings support the hypothesis that, in patients with congenitally corrected transposition, ischemia of the right ventricular myocardium contributes to the development of right ventricular dysfunction.

Keywords

Congenitally corrected transpositionwall motion and thickening
Type
Original Article
Information
Cardiology in the Young , Volume 14 , Issue 2 , April 2004 , pp. 168 - 173
Copyright
© 2004 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Redington AN. Right ventricular function. In: Redington AN, Brawn W, Deanfield JE, Anderson RH (eds). The Right Heart in Congenital Heart Disease. Greenwich Medical Media Ltd, London, 1998, pp 17–24.
Graham TP Jr, Parrish MD, Boucek RJ Jr, Boerth RC, Breitweser JA, Thompson S, Robertson RM, Morgan JR, Friesinger GC. Assessment of ventricular size and function in congenitally corrected transposition of the great arteries. Am J Cardiol 1983; 51: 244–251.Google Scholar
Presbitero P, Somerville J, Rabajoli F, Stone S, Conte MR. Corrected transposition of the great arteries without associated defects in adult patients: clinical profile and follow-up. Br Heart J 1995; 74: 57–59.Google Scholar
Connely MS, Liu PP, Williams WG, Webb GD, Robertson P, McLaughin PR. Congenitally corrected transposition of the great arteries in the adult: functional status and complications. J Am Coll Cardiol 1996; 27: 1238–1243.Google Scholar
Hornung TS, Bernard EJ, Jaeggi ET, Howman-Gilles RB, Cleremajer DS, Hawker RE. Myocardial perfusion defects and associated systemic ventricular dysfunction in congenitally corrected transposition of the great arteries. Heart 1998; 80: 322–326.Google Scholar
Hornung TS, Bernard EJ, Celemajer DS, Jaeggi ET, Howman-Gilles RB, Chard RB, Hawker RE. Right ventricular dysfunction in congenitally corrected transposition of the great arteries. Am J Cardiol 1999; 84: 1116–1119.Google Scholar
Sechtem U, Sommerhof BA, Markiewicz W, White RD, Cheitlin MD, Higgings CB. Regional left ventricular wall thickening by magnetic resonance imaging: Evaluation in normal persons and patients with global and regional dysfunction. Am J Cardiol 1987; 59: 145–151.Google Scholar
Holman ER, Buller VGM, de Ros A, van der Geest RJ, Baur LHB, van der Laarse A, Bruschke AVG, Reiber JHC, van der Wall EE. Detection and quantification of dysfunctional myocardium by magnetic resonance imaging, a new three-dimensional method for quantitative wall thickening analysis. Circulation 1997; 95: 924–931.Google Scholar
Pflugfelder PW, Sechtem UP, White RD, Higgings CB. Quantification of regional myocardial function by rapid cine MR imaging. Am J Roentgenology 1988; 150: 523–529.Google Scholar
Fogel MA, Rychik J. Right ventricular function in congenital heart disease: pressure and volume overload lesions. Prog Cardiovasc Dis 1998; 40: 343–356.Google Scholar
Dodge-Khatami A, Tulevski II, Bennink GBWE, Hitchcock JF, de Mol BAJM, van der Wall EE, Mulder BJM. Comparable MRI dobutamine stress testing in healthy adults and patients with unoperated or physiologically corrected transposition of the great arteries. Can the double switch operation really improve on the already good? Ann Thor Surg 2002; 73: 1759–1764.Google Scholar
Tulevski II, van der Wall EE, Groenink M, Dodge-Khatami A, Hirsch A, Stoker J, Mulder BJM. Usefulness of magnetic resonance imaging dobutamine stress in asymptomatic and minimally symptomatic patients with decreased cardiac reserve from congenital heart disease (complete and corrected transposition of the great arteries and subpulmonic obstruction). Am J Cardiol 2002; 89: 1077–1081.Google Scholar