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)
Sources
Abstract
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.
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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
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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
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18 CitationsSource
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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...
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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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51 CitationsSource
Cited By0
Newest
#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...
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