Prevalence of pulmonary hypertension in adults after atrial switch and role of ventricular filling pressures.

Published on Mar 1, 2021in Heart5.213
· DOI :10.1136/HEARTJNL-2020-317111
William R. Miranda16
Estimated H-index: 16
(Mayo Clinic),
C. Charles Jain4
Estimated H-index: 4
(Mayo Clinic)
+ 4 AuthorsDonald J. Hagler89
Estimated H-index: 89
(Mayo Clinic)
Objective To assess the prevalence of elevated systemic right ventricular (sRV) end-diastolic pressure and pulmonary arterial hypertension in adults with transposition of the great arteries (TGA) who have undergone atrial switch operation. Methods Forty-two adults (aged ≥18 years) with complete TGA and atrial switch palliation undergoing cardiac catheterisation between 2004 and 2018 at Mayo Clinic, MN, were identified. Clinical, echocardiographic and invasive haemodynamic data were abstracted from the medical charts and procedure logs. Results Mean age was 37.6±7.9 years; 28 were male (67%). The Mustard operation was performed in 91% of individuals. Mean estimated sRV ejection fraction by echocardiography was 33.3%±10.9% and ≥moderate tricuspid (systemic atrioventricular valve) regurgitation was present in 15 patients (36%). Mean sRV end-diastolic pressure was 13.2±5.4 mm Hg. An sRV end-diastolic pressure >15 mm Hg was present in 35% of individuals whereas a pulmonary artery wedge pressure (PAWP) >15 mm Hg was seen in 59%. Mean pulmonary artery pressure ≥25 mm Hg was seen in 47.5% of patients with PAWP being >15 mm Hg in all but one patient. Conclusion In adults after atrial switch, elevated sRV end-diastolic pressure was present in only one-third of patients whereas increased PAWP was seen in almost 60%. These findings are most likely related to a combination of decreased pulmonary atrial (functional left atrium) compliance and, in a subset of patients, pulmonary venous baffle obstruction. Elevation in pulmonary pressures was highly prevalent with concomitant elevation in PAWP being present in essentially all patients.
#1Prashanth Venkatesh (NewYork–Presbyterian Hospital)H-Index: 2
#2Arthur T. Evans (NewYork–Presbyterian Hospital)H-Index: 46
Last. Harsimran Singh (NewYork–Presbyterian Hospital)H-Index: 15
view all 15 authors...
Background Existing data on predictors of late mortality and prevention of sudden cardiac death after atrial switch repair surgery for D‐transposition of the great arteries (D‐TGA) are heterogeneou...
12 CitationsSource
#1Yogesh N.V. Reddy (Mayo Clinic)H-Index: 26
#2Abdallah El Sabbagh (Mayo Clinic)H-Index: 11
Last. Rick A. Nishimura (Mayo Clinic)H-Index: 128
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13 CitationsSource
#1Marie-A Chaix (MHI: Montreal Heart Institute)H-Index: 7
#2Annie Dore (MHI: Montreal Heart Institute)H-Index: 27
Last. Paul Khairy (MHI: Montreal Heart Institute)H-Index: 69
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BackgroundThere is a paucity of data regarding late‐onset pulmonary hypertension (PH) in patients with transposition of the great arteries and atrial switch surgery. Methods and ResultsA retrospect...
10 CitationsSource
#1Stephen P. Wright (UHN: University Health Network)H-Index: 12
#2Yasbanoo Moayedi (UHN: University Health Network)H-Index: 5
Last. Susanna Mak (UHN: University Health Network)H-Index: 20
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Background: The diastolic pressure difference (DPD) is recommended to differentiate between isolated postcapillary and combined pre-/postcapillary pulmonary hypertension (Cpc-PH) in left heart disease (PH-LHD). However, in usual practice, negative DPD values are commonly calculated, potentially related to the use of mean pulmonary artery wedge pressure (PAWP). We used the ECG to gate late-diastolic PAWP measurements. We examined the method’s impact on calculated DPD, PH-LHD subclassification, he...
18 CitationsSource
#1Abdallah El Sabbagh (Mayo Clinic)H-Index: 11
#2Yogesh N.V. Reddy (Mayo Clinic)H-Index: 26
Last. Rick A. Nishimura (Mayo Clinic)H-Index: 128
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The surgical Maze procedure and radiofrequency ablation to treat atrial fibrillation are associated with complications that may subsequently lead to dyspnea including left atrial noncompliance, interatrial conduction delays, and pulmonary vein stenosis [(1,2)][1]. A 73-year-old woman presented with
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#1Andreas EickenH-Index: 32
#2Julia MichelH-Index: 1
Last. Peter EwertH-Index: 23
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The atrial baffle repair (ABR) significantly improved the fate of patients with transposition of the great arteries (TGA). However, these patients show impaired exercise tolerance and some present severe decline of systemic ventricular function. Intrinsic myocardial weakness, low heart rate response to exercise and diastolic filling impairment are discussed to be causative. Forty-nine long-term survivors with TGA (median age 23.7 year) after ABR were catheterized with measured oxygen consumption...
4 CitationsSource
#1Pak-Cheong Chow (Queen Mary Hospital)H-Index: 9
#2Xue-cun Liang (Queen Mary Hospital)H-Index: 13
Last. Yiu-fai Cheung (Queen Mary Hospital)H-Index: 37
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Abstract Background We tested the hypothesis that diastolic ventricular interaction occurs after atrial switch operation for transposition of the great arteries (TGA) and that subpulmonary LV diastolic function is influenced by septal geometry. Methods Twenty-nine patients (male 19) after atrial switch operation for TGA aged 20.8±4.1years and 27 healthy controls were studied. Two-dimensional longitudinal systolic strain, systolic (SRs), early diastolic (SRe), and late diastolic (SRa) strain rate...
17 CitationsSource
Many patients with ventriculoarterial discordance have survived to adulthood. Those with complete transposition of the great arteries have often had an atrial switch procedure (Mustard or Senning operation) performed, which leaves the morphological right ventricle (RV) supporting the systemic circulation. RV failure and tricuspid regurgitation are common. Some patients may ultimately require cardiac transplantation. Sinus node dysfunction is increasingly common with longer follow-up, and some pa...
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#1Otto A. SmisethH-Index: 68
#2Christopher R. Thompson (St. Paul's Hospital)H-Index: 68
Last. John B. Bowering (St. Paul's Hospital)H-Index: 7
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OBJECTIVES The purpose of this study was to determine the origin of the pulmonary venous systolic flow pulse using wave-intensity analysis to separate forward- and backward-going waves. BACKGROUND The mechanism of the pulmonary venous systolic flow pulse is unclear and could be a “suction effect” due to a fall in atrial pressure (backward-going wave) or a “pushing effect” due to forward-propagation of right ventricular (RV) pressure (forward-going wave). METHODS In eight patients during coronary...
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#1O. ReichH-Index: 5
#2Voriskova MH-Index: 2
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Objective—To establish the incidence of systolic and diastolic dysfunction of the right and left ventricle in a large cohort of patients after Mustard or Senning operations and to assess changes in the incidence on long term follow up. Design—Postoperative case-control study using radionuclide ventriculography. Ejection fractions, peak filling rates, rapid filling periods and fractions, slow filling periods and fractions, and atrial contraction periods and fractions were studied. Setting—Tertiar...
51 CitationsSource
Cited By0
#1William R. Miranda (Mayo Clinic)H-Index: 16
#2C. Charles Jain (Mayo Clinic)H-Index: 4
Last. Donald J. Hagler (Mayo Clinic)H-Index: 89
view all 3 authors...
Abstract Although the arterial switch operation has become the standard form of surgical repair for complete transposition of the great arteries, a large number of adults post-atrial switch are still followed in current practice. Pulmonary venous baffle obstruction is a well-known complication of the atrial switch operation, mimicking heart failure. Its recognition is important as it is a potentially treatable disease. In the past, retrograde pulmonary venous atrium (PVA)/pulmonary venous baffle...