Main pulmonary artery area limits exercise capacity in patients long-term after arterial switch operation

Vivan J M Baggen; Mieke M P Driessen; Folkert J Meijboom; Gertjan Tj Sieswerda; Nicolaas J G Jansen; Sebastiaan W H van Wijk; Pieter A Doevendans; Tim Leiner; Paul H Schoof; Tim Takken; Johannes M P J Breur

doi:10.1016/j.jtcvs.2015.07.101

Main pulmonary artery area limits exercise capacity in patients long-term after arterial switch operation

Vivan J M Baggen, Mieke M P Driessen, Folkert J Meijboom, Gertjan Tj Sieswerda, Nicolaas J G Jansen, Sebastiaan W H van Wijk, Pieter A Doevendans, Tim Leiner, Paul H Schoof, Tim Takken, Johannes M P J Breur^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVES: Despite excellent survival in patients after the arterial switch operation, reintervention is frequently required and exercise capacity is decreased in a substantial number of patients. This study relates right-sided imaging features in patients long-term after the arterial switch operation to exercise capacity and ventilatory efficiency to investigate which lesions are functionally important.

METHODS: Patients operated in the UMC Utrecht, the Netherlands (1976-2001) and healthy controls underwent cardiac magnetic resonance imaging and cardiopulmonary exercise testing within 1 week. We measured main, left, and right pulmonary artery cross-sectional areas, pulmonary blood flow distribution, peak oxygen uptake, and minute ventilation relative to carbon dioxide elimination.

RESULTS: A total of 71 patients (median age, 20 [12-35] years, 73% were male) and 21 healthy controls (median age, 26 [21-35] years, 48% were male) were included. Main, left, and right pulmonary artery areas were decreased compared with controls (190 vs 269 mm(2)/m(2), 59 vs 157 mm(2)/m(2), 98 vs 139 mm(2)/m(2), respectively, all P < .001); however, pulmonary blood flow distribution was comparable (P = .722). Peak oxygen uptake and minute ventilation relative to carbon dioxide elimination were 88% ± 20% and 23.7 ± 3.8, respectively, with 42% and 1% of patients demonstrating abnormal results (≤ 84% and ≥ 34, respectively). The main pulmonary artery area significantly correlated with peak oxygen uptake (r = 0.401, P = .001) and pulmonary blood flow distribution with minute ventilation relative to carbon dioxide elimination (r = -0.329, P = .008). Subanalysis (<18, 18-25, >25 years) showed that the main pulmonary artery area was smaller in older age groups. In multivariable analysis, the main pulmonary artery area was independently associated with peak oxygen uptake (P = .032).

CONCLUSIONS: In adult patients after the arterial switch operation, narrowing of the main pulmonary artery is a common finding and is the main determinant of limitation in functional capacity, rather than pulmonary branch stenosis.

Original language	English
Pages (from-to)	918-25
Number of pages	8
Journal	Journal of Thoracic and Cardiovascular Surgery
Volume	150
Issue number	4
DOIs	https://doi.org/10.1016/j.jtcvs.2015.07.101
Publication status	Published - 2015

Keywords

20
36
Arterial switch operation
Exercise capacity
Magnetic resonance imaging
Pulmonary artery stenosis
Transposition of great vessels

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10.1016/j.jtcvs.2015.07.101

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Baggen, V. J. M., Driessen, M. M. P., Meijboom, F. J., Sieswerda, G. T., Jansen, N. J. G., van Wijk, S. W. H., Doevendans, P. A., Leiner, T., Schoof, P. H., Takken, T., & Breur, J. M. P. J. (2015). Main pulmonary artery area limits exercise capacity in patients long-term after arterial switch operation. Journal of Thoracic and Cardiovascular Surgery, 150(4), 918-25. https://doi.org/10.1016/j.jtcvs.2015.07.101

@article{867d97273d4c4b74813ec4d0d9c02cb6,

title = "Main pulmonary artery area limits exercise capacity in patients long-term after arterial switch operation",

abstract = "OBJECTIVES: Despite excellent survival in patients after the arterial switch operation, reintervention is frequently required and exercise capacity is decreased in a substantial number of patients. This study relates right-sided imaging features in patients long-term after the arterial switch operation to exercise capacity and ventilatory efficiency to investigate which lesions are functionally important.METHODS: Patients operated in the UMC Utrecht, the Netherlands (1976-2001) and healthy controls underwent cardiac magnetic resonance imaging and cardiopulmonary exercise testing within 1 week. We measured main, left, and right pulmonary artery cross-sectional areas, pulmonary blood flow distribution, peak oxygen uptake, and minute ventilation relative to carbon dioxide elimination.RESULTS: A total of 71 patients (median age, 20 [12-35] years, 73% were male) and 21 healthy controls (median age, 26 [21-35] years, 48% were male) were included. Main, left, and right pulmonary artery areas were decreased compared with controls (190 vs 269 mm(2)/m(2), 59 vs 157 mm(2)/m(2), 98 vs 139 mm(2)/m(2), respectively, all P < .001); however, pulmonary blood flow distribution was comparable (P = .722). Peak oxygen uptake and minute ventilation relative to carbon dioxide elimination were 88% ± 20% and 23.7 ± 3.8, respectively, with 42% and 1% of patients demonstrating abnormal results (≤ 84% and ≥ 34, respectively). The main pulmonary artery area significantly correlated with peak oxygen uptake (r = 0.401, P = .001) and pulmonary blood flow distribution with minute ventilation relative to carbon dioxide elimination (r = -0.329, P = .008). Subanalysis (<18, 18-25, >25 years) showed that the main pulmonary artery area was smaller in older age groups. In multivariable analysis, the main pulmonary artery area was independently associated with peak oxygen uptake (P = .032).CONCLUSIONS: In adult patients after the arterial switch operation, narrowing of the main pulmonary artery is a common finding and is the main determinant of limitation in functional capacity, rather than pulmonary branch stenosis.",

keywords = "20, 36, Arterial switch operation, Exercise capacity, Magnetic resonance imaging, Pulmonary artery stenosis, Transposition of great vessels",

author = "Baggen, {Vivan J M} and Driessen, {Mieke M P} and Meijboom, {Folkert J} and Sieswerda, {Gertjan Tj} and Jansen, {Nicolaas J G} and {van Wijk}, {Sebastiaan W H} and Doevendans, {Pieter A} and Tim Leiner and Schoof, {Paul H} and Tim Takken and Breur, {Johannes M P J}",

year = "2015",

doi = "10.1016/j.jtcvs.2015.07.101",

language = "English",

volume = "150",

pages = "918--25",

journal = "Journal of Thoracic and Cardiovascular Surgery",

issn = "0022-5223",

publisher = "Mosby Inc.",

number = "4",

}

Baggen, VJM, Driessen, MMP, Meijboom, FJ, Sieswerda, GT, Jansen, NJG, van Wijk, SWH, Doevendans, PA , Leiner, T, Schoof, PH, Takken, T & Breur, JMPJ 2015, 'Main pulmonary artery area limits exercise capacity in patients long-term after arterial switch operation', Journal of Thoracic and Cardiovascular Surgery, vol. 150, no. 4, pp. 918-25. https://doi.org/10.1016/j.jtcvs.2015.07.101

TY - JOUR

T1 - Main pulmonary artery area limits exercise capacity in patients long-term after arterial switch operation

AU - Baggen, Vivan J M

AU - Driessen, Mieke M P

AU - Meijboom, Folkert J

AU - Sieswerda, Gertjan Tj

AU - Jansen, Nicolaas J G

AU - van Wijk, Sebastiaan W H

AU - Doevendans, Pieter A

AU - Leiner, Tim

AU - Schoof, Paul H

AU - Takken, Tim

AU - Breur, Johannes M P J

PY - 2015

Y1 - 2015

N2 - OBJECTIVES: Despite excellent survival in patients after the arterial switch operation, reintervention is frequently required and exercise capacity is decreased in a substantial number of patients. This study relates right-sided imaging features in patients long-term after the arterial switch operation to exercise capacity and ventilatory efficiency to investigate which lesions are functionally important.METHODS: Patients operated in the UMC Utrecht, the Netherlands (1976-2001) and healthy controls underwent cardiac magnetic resonance imaging and cardiopulmonary exercise testing within 1 week. We measured main, left, and right pulmonary artery cross-sectional areas, pulmonary blood flow distribution, peak oxygen uptake, and minute ventilation relative to carbon dioxide elimination.RESULTS: A total of 71 patients (median age, 20 [12-35] years, 73% were male) and 21 healthy controls (median age, 26 [21-35] years, 48% were male) were included. Main, left, and right pulmonary artery areas were decreased compared with controls (190 vs 269 mm(2)/m(2), 59 vs 157 mm(2)/m(2), 98 vs 139 mm(2)/m(2), respectively, all P < .001); however, pulmonary blood flow distribution was comparable (P = .722). Peak oxygen uptake and minute ventilation relative to carbon dioxide elimination were 88% ± 20% and 23.7 ± 3.8, respectively, with 42% and 1% of patients demonstrating abnormal results (≤ 84% and ≥ 34, respectively). The main pulmonary artery area significantly correlated with peak oxygen uptake (r = 0.401, P = .001) and pulmonary blood flow distribution with minute ventilation relative to carbon dioxide elimination (r = -0.329, P = .008). Subanalysis (<18, 18-25, >25 years) showed that the main pulmonary artery area was smaller in older age groups. In multivariable analysis, the main pulmonary artery area was independently associated with peak oxygen uptake (P = .032).CONCLUSIONS: In adult patients after the arterial switch operation, narrowing of the main pulmonary artery is a common finding and is the main determinant of limitation in functional capacity, rather than pulmonary branch stenosis.

AB - OBJECTIVES: Despite excellent survival in patients after the arterial switch operation, reintervention is frequently required and exercise capacity is decreased in a substantial number of patients. This study relates right-sided imaging features in patients long-term after the arterial switch operation to exercise capacity and ventilatory efficiency to investigate which lesions are functionally important.METHODS: Patients operated in the UMC Utrecht, the Netherlands (1976-2001) and healthy controls underwent cardiac magnetic resonance imaging and cardiopulmonary exercise testing within 1 week. We measured main, left, and right pulmonary artery cross-sectional areas, pulmonary blood flow distribution, peak oxygen uptake, and minute ventilation relative to carbon dioxide elimination.RESULTS: A total of 71 patients (median age, 20 [12-35] years, 73% were male) and 21 healthy controls (median age, 26 [21-35] years, 48% were male) were included. Main, left, and right pulmonary artery areas were decreased compared with controls (190 vs 269 mm(2)/m(2), 59 vs 157 mm(2)/m(2), 98 vs 139 mm(2)/m(2), respectively, all P < .001); however, pulmonary blood flow distribution was comparable (P = .722). Peak oxygen uptake and minute ventilation relative to carbon dioxide elimination were 88% ± 20% and 23.7 ± 3.8, respectively, with 42% and 1% of patients demonstrating abnormal results (≤ 84% and ≥ 34, respectively). The main pulmonary artery area significantly correlated with peak oxygen uptake (r = 0.401, P = .001) and pulmonary blood flow distribution with minute ventilation relative to carbon dioxide elimination (r = -0.329, P = .008). Subanalysis (<18, 18-25, >25 years) showed that the main pulmonary artery area was smaller in older age groups. In multivariable analysis, the main pulmonary artery area was independently associated with peak oxygen uptake (P = .032).CONCLUSIONS: In adult patients after the arterial switch operation, narrowing of the main pulmonary artery is a common finding and is the main determinant of limitation in functional capacity, rather than pulmonary branch stenosis.

KW - 20

KW - 36

KW - Arterial switch operation

KW - Exercise capacity

KW - Magnetic resonance imaging

KW - Pulmonary artery stenosis

KW - Transposition of great vessels

UR - http://www.scopus.com/inward/record.url?scp=84940094218&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2015.07.101

DO - 10.1016/j.jtcvs.2015.07.101

M3 - Article

C2 - 26318354

AN - SCOPUS:84940094218

SN - 0022-5223

VL - 150

SP - 918

EP - 925

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

IS - 4

ER -

Main pulmonary artery area limits exercise capacity in patients long-term after arterial switch operation

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