Myocardial perfusion and function of the systemic right ventricle in patients after atrial switch procedure for complete transposition:: Long-term follow-up

被引:104
作者
Lubiszewska, B
Gosiewska, E
Hoffman, P
Teresinska, A
Rózanski, J
Piotrowski, W
Rydlewska-Sadowska, W
Kubicka, K
Ruzyllo, W
机构
[1] Natl Inst Cardiol, Dept Gen Cardiol, PL-04628 Warsaw, Poland
[2] Natl Inst Cardiol, Div Nucl Med, PL-04628 Warsaw, Poland
[3] Natl Inst Cardiol, Dept Noninvas Cardiol, PL-04628 Warsaw, Poland
[4] Natl Inst Cardiol, Dept Cardiac Surg, PL-04628 Warsaw, Poland
[5] Natl Inst Cardiol, Dept Cardiovasc Dis Epidemiol & Prevent, PL-04628 Warsaw, Poland
[6] Childrens Mem Hlth Inst, Dept Cardiol, Warsaw, Poland
关键词
D O I
10.1016/S0735-1097(00)00864-0
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES Our purpose was to assess the right ventricular (RV) function and identify patients with RV impairment long after the Mustard or Senning operation. BACKGROUND Systemic Ventricular failure can cause myocardial perfusion abnormalities in thallium scintigraphy correlating with hemodynamic deterioration. METHODS Myocardial perfusion at rest and at peak exercise was assessed in 61 patients, aged 7 to 23 years in mean time 10.0 +/- 2.9 years after surgery using technetium-99m methoxyisobutyl isonitrile single-photon emission computed tomography. Ventricular function was assessed by first-pass radionuclide angiography at rest. Exercise capacity was determined with a modified Bruce protocol. RESULTS The mean RV ejection fraction was 36.1 +/- 7.7%, and left ventricular (LV) ejection fraction was 52.1 +/- 9.4%. Moderate or severe perfusion abnormalities on the rest scan were observed in 20 patients (33%). On exercise perfusion worsened in another 13 patients (21.3%). Patients with perfusion defects on stress scan had significantly lower RV and LV ejection fraction (33.2 vs. 39.4%; p = 0.002 and 49.2 vs. 55.5%; p = 0.01, respectively). They were also older (16.6 vs.13.0 years; p = 0.002), operated on at an older age (4.0 vs. 2.4 years; p = 0.05) and had longer follow-up (12.5 vs. 10.5 years; p = 0.003). CONCLUSIONS Myocardial perfusion defects are common findings in patients in long-term follow-up after atrial switch operation. Despite excellent exercise tolerance, the extent of myocardial perfusion abnormalities correlated well with impaired RV and LV function, and greater perfusion defects were seen more frequently in older patients with longer follow-up. It is likely that myocardial perfusion defects could be a sensitive predictor of systemic ventricular impairment. (J Am Coll Cardiol 2000;36:1365-70) (C) 2000 by the American College of Cardiology.
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页码:1365 / 1370
页数:6
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