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Perfusion defects in patients with complete transposition after the Mustard or Senning operation

Published online by Cambridge University Press:  19 August 2008

Barbara Lubiszewska ,
Elzbieta Gosiewska-Marcinkowska ,
Anna Teresinska ,
Jacek Rozanski ,
Wanda Rydlewska-Sadowska  and
Witold Ruzyllo
Barbara Lubiszewska*
Affiliation:
From the National Institute of Cardiology, Warsaw
Elzbieta Gosiewska-Marcinkowska
Affiliation:
From the National Institute of Cardiology, Warsaw
Anna Teresinska
Affiliation:
From the National Institute of Cardiology, Warsaw
Jacek Rozanski
Affiliation:
From the National Institute of Cardiology, Warsaw
Wanda Rydlewska-Sadowska
Affiliation:
From the National Institute of Cardiology, Warsaw
Witold Ruzyllo
Affiliation:
From the National Institute of Cardiology, Warsaw
*
Dr. Barbara Lubiszewska, Department of General Cardiology, National Institute of Cardiology, Alpejska street 42, 04-628 Waiszawa, Poland. Fax. 48(22) 15-40-03.
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Abstract

Atrial correction for complete transposition involves a potential risk of later development of right ventricular dysfunction. To determine the reasons contributing to such systemic ventricular failure, radioisotope first-pass and SPECT perfusion studies at rest after one dose of Technetium-99m MIBI were performed in 26 asymptomatic patients, 5.9±2.7 years after a Mustard or Senning repair. Mean age at operation was 4.3±4.3 years. All patients were followed with 24-hour Holter monitoring and echocardiography. Normal perfusion was observed in 11 patients with a mean age at operation of 2.25±1.8 years and mean right ventricular ejection fraction of 49.0±8.7%. Perfusion defects were found in 15 patients with a mean age at operation 5.8±4.8 years (p<0.05) and mean right ventricular ejection fraction of 43.2±9.3% (NS). In the group of older patients, 10 had extensive perfusion defects with significantly lower right ventricular ejection fraction (39.7±9.3%, p<0.05) and even older mean age at the surgery (7.1±5.6 years p<0.02). Mild or moderate tricuspid regurgitation was found significantly more frequently in those patients with perfusion defects (73%) than in the group of younger patients (36.3%), p<0.05. There was no difference in the frequency and type of arrhythmias, nor in the extent of follow-up, between the two groups. We conclude that, in patients undergoing surgery at an older age, it is more common to find perfusion defects and, often, lower right ventricular ejection fraction. Perfusion abnormalities found in such asymptomatic patients may be a result of several factors: impaired right ventricular function as a consequence of pressure and volume overload, enhanced myocardial fibrosis, or long-lasting preoperative hypoxemia and tricuspid valvar dysfunction secondary to ventricular dilation. We suggest that the perfusion defects observed in this study may be a better indicator of systemic ventricular impairment.

Keywords

Complete transpositionMustard operationSenning operationright ventricular failureright ventricular perfusionSPECT study
Type
Original Manuscripts
Information
Cardiology in the Young , Volume 6 , Issue 1 , January 1996 , pp. 69 - 75
Copyright
Copyright © Cambridge University Press 1996

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References

1. Mustard, WT. Successful two-stage correction of transposition of the great vessels. Surgery 1964; 55: 469–472.Google ScholarPubMed
2. Senning, A. Surgical correction of transposition of the great vessels. Surgery 1959; 45: 966–980.Google ScholarPubMed
3. Merlo, M, de, Tommasi M, Brunelli, F, Abbruzzese, PA, Crupi, G, Ghidoni, I, Casari, A, Piti, A, Mamprin, F, Parenzan, L. Long-term results after atrial correction of complete transposition of the great arteries. Ann Thorac Surg 1991; 51: 227–231.CrossRefGoogle ScholarPubMed
4. Siebenman, R, von Segesser, L, Schneider, K, Schneider, J, Senning, A, Turina, M. Late failure of systemic ventricle after atrial correction for transposition of great arteries. Eur J Cardiothorac Surg 1989; 3: 119–124.Google Scholar
5. Turina, MI, Siebenman, R, von, Segesser L, Schoenbeck, M, Senning, A. Late functional deterioration after atrial correction for transposition of the great arteries. Circulation 1980; 80(Suppl I): 1162–1167.Google Scholar
6. Dickinson, DF, Scott, O. Ambulatory electrocardiographic monitoring in 100 healthy teenage boys. Br Heart J 1984; 51: 179–183.Google Scholar
7. Southall, DP, Johnston, F, Shinebourne, EA, Johnston, PGB. 24-hour electrocardiographic study of heart rate and rhythm patterns in a population of healthy children. Br Heart J 1981; 45: 281–191.CrossRefGoogle Scholar
8. Quaegebeur, JM, Rohmer, J, Brom, AG. Revival of the Senning operation in the treatment of transposition of the great arteries. Thorax 1977; 32: 517–524.CrossRefGoogle ScholarPubMed
9. Iskandrian, AS, Heo, J, Kong, B, Lyons, E, Marsch, S. Use of Technetium-99m Isonitrile (RP-30A) in assessing left ventricular perfusion and function at rest and during exercise in coronary artery disease, and comparison with coronary arteriography and exercise Thallium-201 SPECT imaging. Am J Cardiol 1989:64: 270–275.Google Scholar
10. Baker, EJ, Shubao, C, Clarke, SEM, Fogelman, I, Maisey, MN, Tynan, M. Radionuclide measurement of right ventricular function in atrial septal defect, ventricular septal defect and complete transposition of the great arteries. Am J Cardiol 1986; 57: 1142–1146.Google Scholar
11. Hurwitz, RA, Caldwell, RL, Girod, DA, Mahony, L, Brown, J, King, H. Ventricular function in transposition of the great arteries: Evaluation by radionuclide angiocardiography. Am Heart J 1985; 110: 600–605.Google Scholar
12. Martin, RP, Qureshi, SA, Ettedgui, JA, Baker, EJ, O'Brien, BJ, Deverall, PB, Yates, AK, Maisey, MN, Radley-Smith, R, Tynan, M, Yacoub, MH. An evaluation of right and left ventricular function after anatomical correction and intraatrial repair operations for complete transposition of the great arteries. Circulation 1990; 82: 808–816.Google Scholar
13. Teresinska, A. A quantitative approach to optimization of SPECT filters for myocardial perfusion studies with Tc-99m MIBI. Eur J Nucl Med 1992; 19: 645. [Abstract]Google Scholar
14. Lubiszewska, B, Gosiewska-Marcinkowska, E,Teresinska, A, Rozanski, J, Rydlewska-Sadowska, W, Ruzyllo, W. Does myocardial perfusion defect determine late systemic ventricular failure after Mustard or Senning procedure? Eur Heart J 1993; 19: 344. [Abstract]Google Scholar
15. Williams, WG, Trusler, GA, Kirklin, JW, Blackstone, EH, Coles, JG, Izukawa, T, Freedom, RM. Early and late results of a protocol for simple transposition leading to an atrial switch (Mustard) repair. J Thorac Cardiovasc Surg 1988: 95: 717–726.Google Scholar
16. Trusler, GA, Williams, WG, Duncan, KF, Hesslein, PS, Benson, LN, Freedom, RM, Izukawa, T, Olley, PM. Results with the Mustard Operation in simple transposition of the great arteries. Ann Surg 1987; 206: 251–260.CrossRefGoogle ScholarPubMed
17. Van Praagh, R. Transposition of the great arteries: History, pathologic anatomy, embryology, etiology, and surgical considerations. In: Mavroudis, C, Backer, CL (eds). The State of the Art Reviews in Cardiac Surgery: The Arterial Switch Operation. Handley and Belfus, Philadelphia, 1991, pp 7–82.Google Scholar
18. Graham, TP Jr, Parish, 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
19. Benson, LN, Bomet, J, McLaughlin, P, Olley, PM, Feiglin, D, Druck, M, Trusler, G, Rowe, KD, Morch, J. Assessment of right ventricular function during supine bicycle exercise after Mustard's operation. Circulation 1982; 65: 1052–1059.Google Scholar
20. Mee, RBB. Severe right ventricular failure after Mustard or Senning operation. Two-stage repair. Pulmonary artery banding and switch. J Thorac Cardiovasc Surg 1986; 92: 385–390.CrossRefGoogle ScholarPubMed
21. Warnes, CA, Somerville, J. Transposition of the great arteries: late results in adolescents and adults after the Mustard procedure. Br Heart J 1987; 58: 148–155.CrossRefGoogle ScholarPubMed
22. Trowitzsch, E, Golan, SD, Sanders, SP. Global and regional right ventricular function in normal infants and infants with transposition of the great arteries after Senning operation. Circulation 1985; 72: 1008–1014.Google Scholar
23. Graham, TP Jr, Burger, J, Bender, HW, Hammon, JW, Boucek, RJ Jr, Appleton, S. Improved right ventricular function after intra-atrial repair of transposition of the great arteries. Circulation 1985; 72(Suppl II): II45–II51.Google Scholar
24. Paridon, SM, Humes, RA, Pinsky, WM. The role of chrono-tropic impairment during exercise after the Mustard operation. J Am Coll Cardiol 1991; 17: 729–732.Google Scholar
25. Ohsuzu, F, Handa, S, Kondo, M, Yamazaki, H, Tsugu, T, Kubo, A, Takagi, Y, Nakamura, Y. Thallium-201 myocardial imaging to evaluate right ventricular overloading. Circulation 1980; 61: 620–625.Google Scholar
26. Rabinovitch, M, Fischer, K, Treves, S. Quantitative Thallium-20 1 myocardial imaging in assessing right ventricular pressure in patients with congenital heart defects. Br Heart J 1981; 45: 198–205.Google Scholar
27. Ono, Y, Tanimoto, T, Kohata, T, Arakaki, Y, Takanashi, S, Takanashi, O, Kamiya, T, Nishimura, T, Kozuka, T, Naitoh, Y. Myocardial imaging in patients with transposition of the great arteries: comparison between Mustard and Rastelli operations. J Cardiogr 1982; 12: 1009–1021.Google Scholar
28. Opie, LH. Ventricular hypertrophy and its molecular biology. In: The Heart. Physiology and Metabolism. Raven Press, New York, 1991, pp 369–424.Google Scholar
29. Redington, AN, Rigby, ML, Oldershaw, P, Gibson, DG, Shinebourne, EA. Right ventricular function 10 years after the Mustard operation for transposition of the great arteries: analysis of size, shape, and wall motion. Br Heart J 1989; 62: 455–461.Google Scholar
30. Okuda, H, Nakazawa, M, Imai, Y, Kurosawa, H, Takanashi, Y, Hoshino, S, Takao, A. Comparison of ventricular function after Senning and Jatene procedures for complete transposition of the great arteries. Am J Cardiol 1985; 55: 530–534.Google Scholar
31. Wong, KY, Venables, AW, Kelly, MJ, Kalf, V. Longitudinal study of ventricular function after the Mustard operation for transposition of the great arteries: a long-term follow-up. Br Heart J 1988; 60: 316–323.CrossRefGoogle ScholarPubMed
32. Murphy, JH, Barlai-Kovach, MM, Mathews, RA, Beerman, LB, Park, SC, Neches, WH, Zuberbuhler, JR. Rest and exercise right and left ventricular function late after the Mustard operation: assessment by radionuclide ventriculography. Am J Cardiol 1983; 51: 1520–1526.CrossRefGoogle ScholarPubMed
33. Borow, KM, Arensman, FW, Webb, C, Radley-Smith, R, Yacoub, MH. Assessment of left ventricular contractile state after anatomic correction of transposition of the great arteries. Circulation 1984; 69: 106–112.Google Scholar
34. Tamai, J, Nagata, S, Nishimura, T, Yutani, C, Miyatake, K, Sakakibara, H, Nimura, Y. Hemodynamic and prognostic value of Thallium-201 myocardial imaging in patients with dilated cardiomyopathy. Int J Cardiol 1989; 24: 219–224.Google Scholar
35. Doi, YL, Chikamori, T, Takata, J, Yonezawa, Y, Poloniecki, JD, Ozawa, T, McKenna, WJ. Prognostic value of Thallium-201 perfusion defects in idiopathic dilated cardiomyopathy. Am J Cardiol 1991; 67: 188–193.Google Scholar
36. Neubauer, S, Krahe, T, Schindler, R, Horn, M, Hillenbrand, H, Entzeroth, C, Mader, H, Kromer, EP, Riegger, GAJ, Lackner, K, Ertl, G. 31P Magnetic resonance spectroscopy in dilated cardiomyopathy and coronary artery disease: altered cardiac high-energy phosphate metabolism in heart failure. Circulation 1992; 86: 1810–1818.Google Scholar