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Abstract
Transposition of great arteries (TGA) is the most common cyanotic congenital heart lesion presenting in the neonate with a male to female ratio of about 3:1. The overall incidence of transposition of great arteries is 20-30 per 100,000 live births.
The arterial switch is the procedure of choice but certain disadvantages may preclude however the use of this operation: certain coronary artery patterns that may pose difficulties during coronary transfer. Also the newborn should be operated preferably within the first two-weeks of life.
Whenever the arterial switch is not feasible, alternative approaches are required at atrial level (atrial switch repair). The major disadvantage of an atrial switch procedure is that the anatomically right ventricle is left as systemic ventricle. Long-term follow-up shows development of right ventricular (RV) failure in up to 7% to 10% of patients per 10 years.
The aim of this study was to assess the right ventricular function in children with (TGA) after atrial switch repair using echocardiography
This study was carried out on 10 children at Alexandria University Children’s Hospital at EL-Shatby aged between (27-108 months), 80 % are males and 20% are females.
Echocardiography revealed that TAPSE was abnormal < 20 mm in 90% of the patients with mean value 14.53 ± 3.04 mm, TAPSE z score was <-2SD in 70% of the patient. the patients RVEDd mean 24.55 ± 5.90 mm was significantly increased than normal reference mean value, while LVEDd 22.90 ± 4.58 mm and LVEDs13.42 ± 2.86 mm were significantly reduced than normal reference mean values.
The patients E/A ratio was less than 1 in one patient with a mean value 1.51 ± 0.52. The MPI of RV was abnormal (higher than 0.32) in 10 patients (100%) with a mean of 0.50±0.14. Tricuspid regurgitation was found in all patients graded as mild in 60%, moderate in 30% and severe in 10%. Mild pulmonary regurgitation was found in 80% of the patients. No pulmonary hypertension was found in our patients. There was no baffle leak detected, no systemic baffle obstruction or stenosis and only one patient had pulmonary baffle stenosis.
In the present study, the mean values of tissue Doppler systolic and diastolic velocities were St in cm/sec was 8.29 ± 2.36, Et in cm/sec was 6.67 ± 2.09 and At in cm/sec was5.86 ± 1.64, which are significantly reduced than normal reference values in healthy children (St in cm/sec 13.0±3.4, Et in cm/sec16.1± 4.7 and At in cm/sec10.2± 2.8).Tissue Doppler Et/At ratio<1 in 40% of the patients.
This showed that right ventricular dysfunction was present in children following atrial switch repair of TGA with variable degrees .Serial monitoring of the RV function using TAPSE, MPI and tissue Doppler imaging are important tools for follow up the patients after atrial switch repair.