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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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