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1.
J Card Surg ; 35(11): 2927-2933, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33111442

RESUMO

OBJECTIVE: The arterial switch operation (ASO) is the standard treatment for the transposition of the great arteries. The timely variation in the residual pressure gradient across the pulmonary arteries is ill-defined. This study is aimed to study the progressive changes in the pressure gradient across the pulmonary valve and pulmonary arteries after ASO. METHODS: All eligible patients for this study who underwent ASO between 2000 and 2019 were reviewed. Transthoracic echocardiography was used to estimate the peak pressure gradient across the pulmonary artery and its branches. The primary outcome was the total peak pressure gradient (TPG) which is the sum of peak pressure gradients across the main pulmonary artery and pulmonary artery branches. Furthermore, longitudinal data analyses with mixed-effect modeling were used to determine the independent predictors for the changes in the pressure gradient. RESULTS: Three hundred and nine patients were included in the study. Over a 17-year follow-up, the freedom from pulmonary stenosis reintervention was 95% (16 out of the 309 patients underwent reintervention = 5%). The longitudinal data analyses of serial 1844 echocardiographic studies for the included patients revealed that the TPG recorded in the first postoperative echocardiogram across pulmonary valve, right and left pulmonary artery branches was the most significant predictor for reintervention. CONCLUSION: The total peak gradient measured in the first postoperative echocardiogram is the most important predictor for reintervention. We propose that a total peak gradient in the first postoperative echocardiography of 55 mm Hg or more is a predictor for reintervention.


Assuntos
Pressão Arterial , Transposição das Grandes Artérias/métodos , Artéria Pulmonar/fisiopatologia , Valva Pulmonar/fisiopatologia , Transposição dos Grandes Vasos/fisiopatologia , Transposição dos Grandes Vasos/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Ecocardiografia , Feminino , Seguimentos , Humanos , Recém-Nascido , Estudos Longitudinais , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Artéria Pulmonar/diagnóstico por imagem , Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/fisiopatologia , Reoperação , Transposição dos Grandes Vasos/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
2.
Kyobu Geka ; 73(8): 614-617, 2020 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-32879292

RESUMO

We successfully performed the DKS+Rastelli procedure for Taussig-Bing anomaly (TBA) in an adult. A 22-year-old male was admitted to our hospital due to persistent lower leg edema and dyspnea. He had been diagnosed with TBA. On physical examination, his peripheral oxygen saturation (Spo2) was 73% in room air. Chest X-ray showed congestive heart failure. We decided to perform arterial switch operation (ASO) and VSD closure. Operation was performed via a re-median sternotomy. It seemed to be very difficult to dissect and mobilize great arteries and coronary arteries for ASO. Therefore, we decided to perform DKS, aortic valve closure, left ventricule to pulmonary artery rerouting, and right ventricular outflow reconstruction using expanded polytetrafluoroethylene (ePTFE) valved conduit. Postoperative course was uneventful, an oxygen saturation was improved. At 5 years after surgery, his oxygen saturation is about 97% in room air and he is now doing well without any symptoms. Long-term follow-up is necessary to ensure maintenance of optimal function.


Assuntos
Transposição das Grandes Artérias , Dupla Via de Saída do Ventrículo Direito , Transposição dos Grandes Vasos , Adulto , Valva Aórtica , Ventrículos do Coração , Humanos , Lactente , Masculino , Artéria Pulmonar , Adulto Jovem
4.
J Extra Corpor Technol ; 52(2): 142-145, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32669741

RESUMO

Bloodless pediatric cardiac surgery requiring the use of cardiopulmonary bypass (CPB) remains a challenge for the entire operating room (OR) team. The amount of circulating blood volume to pump prime volume mismatch of small patients results in hemodilution that frequently results in transfusion of allogeneic blood products. Patients of families of the Jehovah's Witness (JW) faith reject the use of these products because of religious beliefs. Our institution is a referral center for children of JW families because we have developed techniques to minimize blood loss with the hope of performing bloodless pediatric cardiac surgery whenever possible. These techniques include preoperative treatment with erythropoietin, intraoperative acute normovolemic hemodilution, CPB circuit miniaturization, ultrafiltration during and after CPB, limiting blood gas analyses or other unnecessary blood draws, and using hemostatic agents during and after CPB. We present the case of a 4-day-old patient of the JW faith weighing 2.7 kg with transposition of the great arteries and an intact ventricular septum who underwent an arterial switch operation. The patient received no allogeneic blood product administration throughout the entire hospitalization. The patient's first hematocrit in the OR was 43%, lowest hematocrit on bypass was 15%, and first hematocrit in the cardiothoracic intensive care unit post-procedure was 21%. The patient was discharged on post-op day nine with a hematocrit of 36%.


Assuntos
Transposição das Grandes Artérias , Testemunhas de Jeová , Procedimentos Médicos e Cirúrgicos de Sangue , Ponte Cardiopulmonar , Criança , Humanos , Transposição dos Grandes Vasos
5.
J Cardiothorac Surg ; 15(1): 136, 2020 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-32527284

RESUMO

Transposition of the great arteries (TGA) and interruption of the aortic arch (IAA) are uncommon congenital heart diseases. The association between TGA and IAA is rare. The aim of this study is to present a case with combined TGA and IAA, who underwent the primary repair and review the literature with similar cases. The one-month-old patient was admitted with tachypnea and cyanosis. Delayed diagnosis was caused due to the absence of prenatal examination. Echocardiography and computed tomography angiography confirmed TGA with anterior-posterior-oriented great arteries, wide patent ductus arteriosus, type B IAA, ventricular septal defect (VSD) and pulmonary arterial hypertension. The patient underwent a single-stage primary surgical repair process leading to VSD closure, reconstruction of the aortic arch and arterial switch operation in October 2019. The patient is doing well at a 3-month follow-up post-surgery. The echocardiogram suggests a normal systolic function of the ventricles and trivial regurgitation for both aortic and pulmonary valves. CONCLUSIONS: The single-stage repair with VSD closure, reconstruction of aortic arch and arterial switch operation might be an applicable approach for most of the patients with combined TGA and IAA. Long term follow-up is required as a high re-intervention rate for recurrent coarctation, supravalvular aortic stenosis, neoaortic valve regurgitation, obstruction of the right heart system and coronary stenosis has been reported.


Assuntos
Aorta Torácica/anormalidades , Aorta Torácica/cirurgia , Permeabilidade do Canal Arterial/cirurgia , Comunicação Interventricular/cirurgia , Transposição dos Grandes Vasos/cirurgia , Transposição das Grandes Artérias , Humanos , Lactente , Masculino , Hipertensão Arterial Pulmonar/complicações , Valva Pulmonar
6.
Asian Cardiovasc Thorac Ann ; 28(6): 333-335, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32551840

RESUMO

The introduction of the arterial switch operation has improved the surgical outcome of transposition of the great arteries. However, coronary anomalies such as intramural coronary arteries, single coronary artery, or coronary arteries originating from a single arterial sinus have been reported as independent risk factors for early mortality and late morbidity after an arterial switch operation. We performed an arterial switch operation using a unique technique for translocation of the coronary arteries originating from a single left-side arterial sinus, to prevent coronary artery distortion and subsequent coronary malperfusion.


Assuntos
Transposição das Grandes Artérias , Seio Coronário/cirurgia , Anomalias dos Vasos Coronários/cirurgia , Transposição dos Grandes Vasos/cirurgia , Seio Coronário/anormalidades , Seio Coronário/diagnóstico por imagem , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Humanos , Lactente , Transposição dos Grandes Vasos/complicações , Transposição dos Grandes Vasos/diagnóstico por imagem , Resultado do Tratamento
7.
Am J Cardiol ; 129: 87-94, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32593432

RESUMO

Several studies have reported aortic dilation and increased stiffness of the ascending aorta in patients after repair of congenital heart disease (CHD), which may be a predominant cardiovascular risk. However, the clinical significance has not been described in detail. In this retrospective study, 175 repaired patients with complex CHD achieving biventricular circulation and age-matched 39 control subjects were reviewed (median age: 14.9 and 15.7 years, respectively). We measured the diameters of the ascending aorta and descending aorta from catheterization angiograms to yield Z-scores and stiffness indexes (ß) using diameter fluctuations corresponding to pulsatile pressures. Clinical profile, peak oxygen uptake during the cardiopulmonary exercise test, and incidence of unscheduled hospitalization during follow-up was also reviewed. Compared with controls, patients with complex CHD, except for those with aortic coarctation, exhibited significant dilation and increased stiffness of the aortic root and ascending aorta, but not of the descending aorta. In this CHD population (n = 147, including 112 conotruncal anomalies), exercise capacities correlated independently with the diameter Z-score and stiffness index of the ascending aorta along with the history of repetitive thoracotomies, reduced forced vital capacity, and right ventricular hypertension. During a follow-up period (median 15.6 years), either dilation (Z-score >3.5) or increased stiffness (ß >6.0) of the ascending aorta stratified morbidity, but no synergistic impact was detected. In conclusion, in repaired patients with complex CHD, a stiffened and dilated ascending aorta was frequently found, exerting significant adverse impacts on diminished exercise capacity and morbidity.


Assuntos
Aorta/fisiopatologia , Doenças da Aorta/fisiopatologia , Tolerância ao Exercício/fisiologia , Cardiopatias Congênitas/fisiopatologia , Rigidez Vascular/fisiologia , Adolescente , Coartação Aórtica/fisiopatologia , Coartação Aórtica/cirurgia , Insuficiência da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/fisiopatologia , Transposição das Grandes Artérias , Procedimentos Cirúrgicos Cardíacos , Estudos de Casos e Controles , Criança , Dilatação Patológica/fisiopatologia , Dupla Via de Saída do Ventrículo Direito/fisiopatologia , Dupla Via de Saída do Ventrículo Direito/cirurgia , Feminino , Cardiopatias Congênitas/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Tetralogia de Fallot/fisiopatologia , Tetralogia de Fallot/cirurgia , Transposição dos Grandes Vasos/fisiopatologia , Transposição dos Grandes Vasos/cirurgia , Persistência do Tronco Arterial/fisiopatologia , Persistência do Tronco Arterial/cirurgia
8.
J Card Surg ; 35(7): 1664-1668, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32383229

RESUMO

INTRODUCTION: In adult congenital patients with transposition of the great arteries originally treated with the Mustard (atrial switch) procedure, the most common reason for re-intervention is baffle stenosis. This may be exacerbated by permanent transvenous pacemaker lead placement across the baffle. CASE REPORT: A 47-year-old female status post Mustard procedure performed at 15 months old presented with a high-grade stenosis of the superior vena cava (SVC) baffle from the SVC to the left atrium, with a nonfunctional permanent pacemaker lead passing through the baffle. A mechanical rotating dilator sheath was used for attempted lead extraction, relieving the baffle stenosis almost completely as a secondary effect, before the placement of a 10 × 27 mm Visipro balloon-expandable stent in the SVC baffle. CONCLUSIONS: Use of the mechanical rotating dilator sheath is an evolving treatment strategy in adult congenital heart disease to minimize the risk of bleeding, trauma to surrounding structures, and death. Its ability to fully alleviate baffle stenosis even when full lead extraction is not feasible or is associated with significant procedural risk, further demonstrates its expanded role in this patient population. A multidisciplinary approach and great diligence must be employed to avoid potential complications.


Assuntos
Transposição das Grandes Artérias/métodos , Remoção de Dispositivo/instrumentação , Marca-Passo Artificial/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Transposição dos Grandes Vasos/cirurgia , Veia Cava Superior/patologia , Veia Cava Superior/cirurgia , Transposição das Grandes Artérias/efeitos adversos , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Remoção de Dispositivo/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Stents Metálicos Autoexpansíveis , Resultado do Tratamento
9.
BMC Cardiovasc Disord ; 20(1): 216, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393237

RESUMO

BACKGROUND: Jehovah's Witnesses refuse allogeneic blood transfusions, which makes cardiovascular surgery challenging. Surgeons must minimize blood and fluid loss within one procedure. CASE PRESENTATION: We herein describe a 17-year-old male Jehovah's Witness with bicuspid aortic valve regurgitation and coarctation of the aorta. The procedures were performed in the following order: aortic valve replacement combined with Nick's aortic root enlargement, right axillary artery-bilateral external iliac artery bypass, and distal arch-descending aorta bypass. CONCLUSIONS: Axillary artery-bilateral external iliac artery bypass maintained distal perfusion and reduced the amount of heparin during distal arch-descending aorta bypass surgery.


Assuntos
Coartação Aórtica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/anormalidades , Transposição das Grandes Artérias , Perda Sanguínea Cirúrgica/prevenção & controle , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Testemunhas de Jeová , Recuperação de Sangue Operatório , Religião e Medicina , Adolescente , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/fisiopatologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/fisiopatologia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Masculino , Resultado do Tratamento
10.
Int Heart J ; 61(3): 616-619, 2020 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-32418970

RESUMO

We experienced a 33-year-old patient with D-looped transposition of the great arteries (D-TGA) and a history of Senning operation who was referred to our institute with cardiogenic shock and subsequently underwent urgent paracorporeal ventricular assist device (VAD) implantation, which was a first in Japan, that was eventually converted to a durable VAD. Central venous pressure was maintained relatively high to obtain VAD filling and recover end-organ dysfunction, given the migration of the inflow cannula due to rich trabeculae carneae of the anatomical right ventricle (systemic ventricle in this case).


Assuntos
Coração Auxiliar , Implantação de Prótese , Choque Cardiogênico/cirurgia , Transposição dos Grandes Vasos , Adulto , Transposição das Grandes Artérias , Feminino , Humanos , Transposição dos Grandes Vasos/cirurgia
11.
Ann Thorac Surg ; 110(4): e279-e280, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32311344

RESUMO

Systemic right ventricle failure often develops in patients with dextro-transposition of the great arteries who have undergone atrial-level switch procedures. An adult with dextro-transposition of the great arteries with Mustard repair in childhood presented with end-stage heart failure due to systemic right ventricle failure, Mustard baffle leak, and unrepaired partial anomalous pulmonary venous return. She underwent device closure of the baffle leak by catheterization, followed by baffle revision and concomitant systemic ventricular assist device placement by adult and pediatric heart surgeons. This case demonstrates the importance of multidisciplinary collaboration between pediatric and adult heart failure specialists in caring for complex adult congenital heart patients.


Assuntos
Transposição das Grandes Artérias , Insuficiência Cardíaca/cirurgia , Coração Auxiliar , Complicações Pós-Operatórias/cirurgia , Transposição dos Grandes Vasos/cirurgia , Adulto , Feminino , Humanos , Reoperação
12.
Braz J Cardiovasc Surg ; 35(1): 113-116, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-32270968

RESUMO

A 30-month-old male patient with transposition of the great arteries with intact ventricular septum (TGA/IVS) is presented. Arterial switch operation (ASO) was performed in the light of echocardiographic and angiographic findings. The patient remained under extracorporeal membrane oxygenation support for seven days postoperatively, and his cardiac functions returned to normal at the postoperative 10th day. He was discharged at the postoperative 20th day. The present case, which presents one of the most advanced ages at operation for TGA/IVS among previously reported cases, is used to discuss late ASO in this study.


Assuntos
Transposição das Grandes Artérias , Oxigenação por Membrana Extracorpórea , Transposição dos Grandes Vasos , Septo Interventricular , Pré-Escolar , Humanos , Masculino , Resultado do Tratamento , Septo Interventricular/cirurgia
13.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 30(2 Suppl. B): 123-123, abr-jun., 2020.
Artigo em Português | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1116807

RESUMO

INTRODUÇÃO: Historicamente, a cardiopatia congênita traz redução da qualidade de vida da criança portadora da patologia. Com o aprimoramento das formas de correção, estes pacientes apresentam melhor sobrevida, de forma que hoje há mais adultos com cardiopatia congênita. A prática de atividade física vem sendo encorajada nesses pacientes. Relatamos um caso de um paciente portador de cardiopatia congênita cianótica corrigida nos primeiros dias de vida, atualmente praticante de atividade física. Relato de caso: Paciente masculino, 26 anos, com dextro transposição de grandes artérias (DTGA), comunicação interatrial e persistência do canal arterial. Aos 09 dias de vida, submetido a procedimento para correção da cardiopatia, por meio da cirurgia de Jatene (CJ) com manobra de Lecompte. Aos 18 anos manifestou desejo de praticar atividade física, sendo feita avaliação pré-participação. Cintilografia do Miocárdio com ausência de sinais de isquemia; Teste ergométrico (TE) com boa capacidade funcional, Extras sístoles ventriculares isoladas e raras; ecocardiograma transtorácico dentro da normalidade. Atualmente realiza atividade física resistida (musculação 80 min por dia, 6 dias por semana), sem sintomas durante a prática ou o repouso. Em exames atuais observa--se: TE em ritmo atrial multifocal, sem alterações sugestivas de isquemia, com boa capacidade aeróbica (16,2 METs e VO2 56 mL/kg. min); Ressonância miocárdica com câmaras cardíacas de dimensões preservadas, função sistólica biventricular preservada, ausência de áreas de edema, gordura ou fibrose. DISCUSSÃO e CONCLUSÃO: A DTGA corresponde a cerca de 8% de todas as cardiopatias congênitas, com alto índice de letalidade antes do surgimento de correções cirúrgicas, chegando a 90% de mortalidade no primeiro ano de vida. Inicialmente reduzia-se danos da DTGA através de correção atrial. Com o desenvolvimento da CJ (ou switch arterial) houve melhora progressiva do prognóstico e qualidade de vida, principalmente se realizada nos primeiros dias de vida. Devido a isso, muitos pacientes submetidos à CJ praticam exercícios físicos ou atividades competitivas, tornando o acompanhamento um desafio para o cardiologista, visto que não há evidências robustas sobre os impactos de tais atividades a longo prazo. Conclui-se a importância de seguimento com exames periódicos de tais pacientes, com coleta de dados e a necessidade de mais estudos para este cenário.


Assuntos
Exercício Físico , Transposição das Grandes Artérias , Cardiopatias Congênitas
15.
J Thorac Cardiovasc Surg ; 160(1): 191-199.e1, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32222408

RESUMO

OBJECTIVE: We sought to determine the influence of coronary artery anatomy on mortality in more than 1000 children undergoing the arterial switch operation. METHODS: All patients who underwent an arterial switch operation were identified from 2 hospital databases and reviewed retrospectively. Coronary anatomy was recorded from operative reports using the Leiden classification. RESULTS: An arterial switch operation was performed in 1033 children between 1983 and 2013. Coronary anatomy was normal in 697 patients (67%). The most common type of anomalous coronary anatomy was the circumflex coronary artery arising from sinus 2 (in 152 patients [15%]). Forty-seven patients (4.5%) had all coronary arteries arising from a single sinus. Of these 47 patients, 34 patients (3.3%) had a true single coronary artery. Fifty-two patients (5.0%) had an intramural coronary artery. Overall early mortality was 3.3% (34 out of 1033 patients) over the 30-year period. Early mortality was 3.0% (21 out of 697) for patients with normal coronary anatomy and 3.9% (13 out of 336) for any type of anomalous coronary anatomy. Early mortality was 3.3% (5 out of 152) for patients with the circumflex coronary artery arising from sinus 2, 6.4% (3 out of 47) for patients with all coronary arteries arising from a single sinus, and 5.9% (2 out of 34) for patients with a true single coronary artery. Early mortality for patients with intramural coronaries was 1.9% (1 out of 52). No coronary pattern was found to be a risk factor for mortality. CONCLUSIONS: Patients with anomalous coronary artery anatomy had higher rates of early mortality after the arterial switch operation but this was not statistically significant. Coronary artery reoperations were rare.


Assuntos
Transposição das Grandes Artérias/mortalidade , Anomalias dos Vasos Coronários/mortalidade , Vasos Coronários , Anomalias dos Vasos Coronários/complicações , Vasos Coronários/anatomia & histologia , Vasos Coronários/patologia , Humanos , Recém-Nascido , Estudos Retrospectivos , Transposição dos Grandes Vasos/complicações , Transposição dos Grandes Vasos/cirurgia
16.
J Card Surg ; 35(5): 1085-1089, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32207192

RESUMO

Hypoplastic ascending aorta and interrupted aortic arch (IAA) are rarely associated with dextro-transposition of the great arteries (D-TGA). Severe hypoplastic ascending aorta may preclude coronary artery transfer making arterial switch operation problematic. We report a case of D-TGA with a large subpulmonic ventricular septal defect, IAA, and hypoplastic ascending aorta that underwent successful biventricular surgical repair without coronary artery transfer.


Assuntos
Aorta/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/métodos , Transposição dos Grandes Vasos/cirurgia , Anormalidades Múltiplas , Aorta/patologia , Aorta Torácica/anormalidades , Aorta Torácica/cirurgia , Transposição das Grandes Artérias , Vasos Coronários/cirurgia , Feminino , Comunicação Interventricular/cirurgia , Humanos , Recém-Nascido
17.
J Thorac Cardiovasc Surg ; 160(1): 200-201, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32007253
19.
Pediatr Cardiol ; 41(4): 747-754, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32006085

RESUMO

We tested the hypothesis that left ventricular (LV) myocardial stiffness is altered in patients with transposition of great arteries (TGA) after arterial switch operation (ASO) and explored its associations with myocardial calibrated integrated backscatter (cIB) and LV myocardial deformation. Thirty-one patients and twenty-two age-matched controls were studied. LV myocardial stiffness was assessed by diastolic wall strain (DWS) and stiffness indices including (E/e)/LV end-diastolic dimension, (E/LV global longitudinal early diastolic strain rate)/LV end-diastolic volume, and (E/LV global circumferential early diastolic strain rate)/LV end-diastolic volume, where E and e are early diastolic transmitral and mitral annular velocities, respectively. LV myocardial cIB and longitudinal and circumferential myocardial deformation were determined by conventional and speckle tracking echocardiography. Patients had significantly lower DWS, higher stiffness indices, and greater myocardial cIB than controls (all p < 0.05). The LV longitudinal and circumferential systolic strain and systolic and diastolic strain rates were significantly lower in patients than controls (all p < 0.05). Greater average myocardial cIB was associated with lower DWS (r = - 0.44, p = 0.002). Worse DWS and LV stiffness indices were found to correlate with lower mitral annular systolic velocity, mitral annular late diastolic velocity, and LV longitudinal late diastolic strain rate (all p < 0.05). LV longitudinal and circumferential systolic strain and strain rate were also found to correlate with DWS (all p < 0.05). In conclusion, LV myocardial stiffening occurs in adolescents and young adults with TGA after ASO and is associated with impairment of ventricular systolic and diastolic myocardial deformation and myocardial fibrosis.


Assuntos
Transposição das Grandes Artérias/efeitos adversos , Ventrículos do Coração/fisiopatologia , Transposição dos Grandes Vasos/cirurgia , Disfunção Ventricular Esquerda/etiologia , Adolescente , Criança , Ecocardiografia/métodos , Feminino , Fibrose , Humanos , Masculino , Miocárdio/patologia , Estudos Retrospectivos , Disfunção Ventricular Esquerda/patologia , Adulto Jovem
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