Role of advanced MRI techniques in comparison of systemic ventricle in atrial switch and congenitally corrected transposition of the great vessels
Sameh Nabil Kamel Khalil;
Abstract
Incidence of transposition of great arteries (TGA) is 1 per 3300 live birth according to the center of disease control and prevention.
TGA is subdivided into 2 types; dextro-transposition of great arteries (d-TGA) which is the most common type with an atrio-ventricular concordance and ventriculo- arterial discordance, the other type is levo-transposition of great arteries (l-TGA) with atrio-ventricular and ventriculo-arterial discordance, l-TGA is also known as congenitally corrected transposition of great arteries (cc-TGA).
Atrial switch is one of the surgical procedures done for d-TGA by redirecting the deoxygenated blood into the left ventricle which pumps blood into pulmonary artery and redirecting the oxygenated blood through pulmonary baffle to the right ventricle which acts as a systemic ventricle pumping oxygenated blood into the aorta. This procedure is indicated when there is no chance to proceed for arterial switch as the left ventricle is not conditioned to act as a systemic ventricle. Survival is 68% after 39 years while survival free of events like arrhythmias, heart failure and reoperation is 19% only after 39 years.
These figures raise questions about the underlying mechanisms of atrial switch complications on the long run, diffuse myocardial fibrosis is considered as a prominent problem. Underlying etiology of diffuse systemic ventricle fibrosis is an area of further researches helping to clarify the risk factors which could be the late atrial switch palliation sparing more time for deoxygenated blood to harm the myocardium or the hemodynamic burden on the systemic right ventricle in addition to the exposure to major cardiac surgery with decreased oxygen saturation.
Despite being congenitally corrected since birth by having similar circulation as atrial switch patients with right ventricle acting as a systemic ventricle pumping oxygenated blood to aorta, ccTGA patients have high incidence of systemic ventricle failure (up to 34% in case of absent associated other cardiac anomalies and 70% if other anomalies present) and premature death even without associated cardiac anomalies. This encourages the idea of anatomical repair by doing atrial and arterial switch in the same patient.
Still the gap of knowledge about the different performance of the systemic ventricle in atrial switch and ccTGA patients, is there an effect of the low oxygen saturation before and at the time of surgery in case of atrial switch? which could be the leading point in diffuse myocardial fibrosis in this cohort. What is the effect of the hemodynamic burden on the systemic right ventricle? Is the idea of anatomical repair a wise idea or it leads to more complications (complications of 2 different surgeries together in the same patient)?
TGA is subdivided into 2 types; dextro-transposition of great arteries (d-TGA) which is the most common type with an atrio-ventricular concordance and ventriculo- arterial discordance, the other type is levo-transposition of great arteries (l-TGA) with atrio-ventricular and ventriculo-arterial discordance, l-TGA is also known as congenitally corrected transposition of great arteries (cc-TGA).
Atrial switch is one of the surgical procedures done for d-TGA by redirecting the deoxygenated blood into the left ventricle which pumps blood into pulmonary artery and redirecting the oxygenated blood through pulmonary baffle to the right ventricle which acts as a systemic ventricle pumping oxygenated blood into the aorta. This procedure is indicated when there is no chance to proceed for arterial switch as the left ventricle is not conditioned to act as a systemic ventricle. Survival is 68% after 39 years while survival free of events like arrhythmias, heart failure and reoperation is 19% only after 39 years.
These figures raise questions about the underlying mechanisms of atrial switch complications on the long run, diffuse myocardial fibrosis is considered as a prominent problem. Underlying etiology of diffuse systemic ventricle fibrosis is an area of further researches helping to clarify the risk factors which could be the late atrial switch palliation sparing more time for deoxygenated blood to harm the myocardium or the hemodynamic burden on the systemic right ventricle in addition to the exposure to major cardiac surgery with decreased oxygen saturation.
Despite being congenitally corrected since birth by having similar circulation as atrial switch patients with right ventricle acting as a systemic ventricle pumping oxygenated blood to aorta, ccTGA patients have high incidence of systemic ventricle failure (up to 34% in case of absent associated other cardiac anomalies and 70% if other anomalies present) and premature death even without associated cardiac anomalies. This encourages the idea of anatomical repair by doing atrial and arterial switch in the same patient.
Still the gap of knowledge about the different performance of the systemic ventricle in atrial switch and ccTGA patients, is there an effect of the low oxygen saturation before and at the time of surgery in case of atrial switch? which could be the leading point in diffuse myocardial fibrosis in this cohort. What is the effect of the hemodynamic burden on the systemic right ventricle? Is the idea of anatomical repair a wise idea or it leads to more complications (complications of 2 different surgeries together in the same patient)?
Other data
| Title | Role of advanced MRI techniques in comparison of systemic ventricle in atrial switch and congenitally corrected transposition of the great vessels | Other Titles | دور رنين القلب المغناطيسي في تقييم البطين الايمن المتصل بالدورة الجهازية في حالة ما بعد الانقلاب الاذيني مقارنة بمرضى انقلاب وضع الاوعية الكبرى المصوب خلقيا | Authors | Sameh Nabil Kamel Khalil | Issue Date | 2019 |
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