TY - JOUR
T1 - The impact of unilateral pulmonary artery stenosis on right ventricular to pulmonary arterial coupling in patients with transposition of the great arteries
AU - Joosen, Renée S.
AU - Voskuil, Michiel
AU - Krings, Gregor J.
AU - Handoko, M. Louis
AU - Dickinson, Michael G.
AU - van de Veerdonk, Marielle C.
AU - Breur, Johannes M.P.J.
N1 - Publisher Copyright:
© 2024 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.
PY - 2024/5/1
Y1 - 2024/5/1
N2 - Background: Unilateral pulmonary artery (PA) stenosis is common in the transposition of the great arteries (TGA) after arterial switch operation (ASO) but the effects on the right ventricle (RV) remain unclear. Aims: To assess the effects of unilateral PA stenosis on RV afterload and function in pediatric patients with TGA-ASO. Methods: In this retrospective study, eight TGA patients with unilateral PA stenosis underwent heart catheterization and cardiac magnetic resonance (CMR) imaging. RV pressures, RV afterload (arterial elastance [Ea]), PA compliance, RV contractility (end-systolic elastance [Ees]), RV-to-PA (RV-PA) coupling (Ees/Ea), and RV diastolic stiffness (end-diastolic elastance [Eed]) were analyzed and compared to normal values from the literature. Results: In all TGA patients (mean age 12 ± 3 years), RV afterload (Ea) and RV pressures were increased whereas PA compliance was reduced. RV contractility (Ees) was decreased resulting in RV-PA uncoupling. RV diastolic stiffness (Eed) was increased. CMR-derived RV volumes, mass, and ejection fraction were preserved. Conclusion: Unilateral PA stenosis results in an increased RV afterload in TGA patients after ASO. RV remodeling and function remain within normal limits when analyzed by CMR but RV pressure–volume loop analysis shows impaired RV diastolic stiffness and RV contractility leading to RV-PA uncoupling.
AB - Background: Unilateral pulmonary artery (PA) stenosis is common in the transposition of the great arteries (TGA) after arterial switch operation (ASO) but the effects on the right ventricle (RV) remain unclear. Aims: To assess the effects of unilateral PA stenosis on RV afterload and function in pediatric patients with TGA-ASO. Methods: In this retrospective study, eight TGA patients with unilateral PA stenosis underwent heart catheterization and cardiac magnetic resonance (CMR) imaging. RV pressures, RV afterload (arterial elastance [Ea]), PA compliance, RV contractility (end-systolic elastance [Ees]), RV-to-PA (RV-PA) coupling (Ees/Ea), and RV diastolic stiffness (end-diastolic elastance [Eed]) were analyzed and compared to normal values from the literature. Results: In all TGA patients (mean age 12 ± 3 years), RV afterload (Ea) and RV pressures were increased whereas PA compliance was reduced. RV contractility (Ees) was decreased resulting in RV-PA uncoupling. RV diastolic stiffness (Eed) was increased. CMR-derived RV volumes, mass, and ejection fraction were preserved. Conclusion: Unilateral PA stenosis results in an increased RV afterload in TGA patients after ASO. RV remodeling and function remain within normal limits when analyzed by CMR but RV pressure–volume loop analysis shows impaired RV diastolic stiffness and RV contractility leading to RV-PA uncoupling.
KW - cardiac magnetic resonance imaging
KW - pulmonary pressures
KW - pulmonary stenosis
KW - right ventricular dysfunction
KW - transposition of the great arteries
UR - http://www.scopus.com/inward/record.url?scp=85190365281&partnerID=8YFLogxK
U2 - 10.1002/ccd.31036
DO - 10.1002/ccd.31036
M3 - Article
C2 - 38577955
AN - SCOPUS:85190365281
SN - 1522-1946
VL - 103
SP - 943
EP - 948
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 6
ER -