Left bundle pacing in transposition of the great arteries with previous atrial redirection operation.
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ABSTRACT:
SUBMITTER: O'Connor M
PROVIDER: S-EPMC9039560 | biostudies-literature | 2022 Mar
REPOSITORIES: biostudies-literature
Publications
Left bundle pacing in transposition of the great arteries with previous atrial redirection operation.
O'Connor Matthew M Ho S Yen SY McCarthy Karen P KP Gatzoulis Michael M Wong Tom T
HeartRhythm case reports 20211207 3
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Project description:As long-term outcomes of congenital heart diseases improve, the probability of adult patients presenting for heart transplantation for late failure of congenitally corrected heart disease also increases. In patients with dextro-transposition of the great arteries (d-TGA) who were initially treated in the era of Mustard or Senning procedures and before Jatene procedure was introduced, progressive systemic right ventricular failure represents a problem in the very long-term follow-up. We report a rare case of heart transplantation as a third operation 36 years after Mustard procedure in a patient with d-TGA experiencing late failure of the systemic right ventricle.
| S-EPMC8502455 | biostudies-literature
Project description:Introduction: Adult survivors of the atrial switch operation for transposition of the great arteries present with a systemic morphologic right ventricle and a subpulmonary morphologic left ventricle. This physiology can be considered a model for the effects of long-term right ventricular pressure overload and of decreased left ventricular afterload. We aimed to determine the impact of these chronically altered loading conditions on myocardial deformation of the ventricles. Materials and methods: Two-dimensional steady state free precession cine images of 29 patients after atrial repair (age 29 ± 7 years) and 19 controls (24 ± 10 years; n.s.) were post-processed with feature tracking software (TomTec 2D CPA). Volumes, ejection fractions, global and free wall longitudinal and circumferential strains of both ventricles were compared between both groups. Results: Systemic right ventricular global longitudinal strain was decreased in patients compared to controls (-12.9 ± 3.3% vs. -18.9 ± 4.6%, p < 0.001), while right ventricular circumferential strain was unchanged (-15.8 ± 3.4% vs. -15.1 ± 5%; n.s.). Left ventricular longitudinal strain was similar in both groups (-17 ± 5.6% vs. -17.5 ± 4.6%; n.s.), but global left ventricular circumferential strain was lower in patients (-20.7 ± 4.1% vs. -27.3 ± 4.5%, p < 0.001). The systemic right ventricle, compared to the systemic left ventricle, showed decreased global longitudinal (p < 0.001) and circumferential strain (p < 0.001). The subpulmonary left ventricle, compared to the subpulmonary right ventricle, demonstrated similar longitudinal (p = 0.223) but higher circumferential strain (p < 0.001). Conclusions: In patients after atrial switch repair for transposition of the great arteries, the systemic right ventricle shows poor longitudinal strain, but maintains normal right ventricular circumferential strain. The left ventricle shows higher circumferential strain than the right ventricle, in both systemic and subpulmonary positions.
| S-EPMC6465947 | biostudies-literature
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| S-EPMC10405312 | biostudies-literature
Project description:The patient presented with flash pulmonary edema related to severe left ventricular diastolic dysfunction several weeks after arterial switch operation (ASO) for D-transposition of the great arteries. Long segment, critical left main coronary artery stenosis in this 3.6 kilogram infant was successfully stented and resulted in resolution of the clinical findings. At 15-month follow-up, the patient remains asymptomatic and thriving.
| S-EPMC4453185 | biostudies-literature
Project description:BackgroundDextro-transposition of the great arteries (dTGA) is one of the most common cyanotic congenital heart defects, when the origins of the main arteries are switched in position. The present retrospective cohort study aimed three-dimensional speckle-tracking echocardiography-derived determination of apical and basal morphologic left ventricular (mLV) rotations and twist in adults with dTGA late after atrial switch. It was also purposed to compare whether differences in mLV rotational parameters were present in Senning- and Mustard-operated subjects.MethodsSixteen dTGA patients were willing to participate late after atrial switch in this study, however, 6 subjects were excluded due to inferior image quality. The remaining group of 10 dTGA patients had a mean age of 29.4±8.8 years (5 males). Their clinical data were from the CSONGRAD Registry. Their results were compared to 24 age- and gender-matched healthy controls with a mean age of 34.4±12.6 years (14 males).ResultsFrom the dTGA patient population, only 5 out of 10 subjects had normally directed mLV rotational mechanics, 5 dTGA cases had significant mLV rotational abnormality with counterclockwise mLV basal rotation in 4 patients (mLV rigid body rotation, mLV-RBR). One patient had complete reversal of apical and basal mLV rotations. Compared to the matched healthy controls, dTGA patients showed mLV-RBR significantly more frequently (50% vs. 0%, P=0.0009) regardless of the fact whether Senning- or Mustard-procedure was performed. dTGA patients with normally directed mLV rotational mechanics proved to have increased mLV basal rotation (-7.9±4.1 vs. -3.7±1.9 degree, P=0.001) with preserved mLV twist (16.4±3.3 vs. 14.0±4.1 degree, P=ns) as compared to matched controls.ConclusionsSignificant mLV rotational abnormalities are present in dTGA late after atrial switch procedures including mLV-RBR and reversed mLV twist. In dTGA patients with normally directed mLV rotational mechanics, mLV basal rotation is increased with preserved mLV twist. Some differences in mLV rotational abnormalities are present between Senning- and Mustard-procedures.
| S-EPMC9622401 | biostudies-literature
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| S-EPMC10267809 | biostudies-literature
Project description:BackgroundMyocardial fibrosis is a potential pathophysiological mechanism leading to systemic right ventricular (SRV) deterioration. We hypothesize that circulating levels of collagen deposition markers are elevated in patients with SRV remodeling and this elevation may have a predictive value.MethodsWe prospectively evaluated 56 patients with D-TGA after the atrial switch procedure (mean age 25.6 ± 4.8, range 18-37 years; 67% males). Serum levels of procollagen type III amino-terminal propeptide (PIIINP), collagen type I carboxy-terminal telopeptide (CITP), procollagen type I N-terminal propeptide (PINP), matrix metalloproteinase (MMP 1, MMP 9) and a tissue inhibitor of matrix metalloproteinase (TIMP 1) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) were measured and compared with healthy controls. The relationship between these serum markers, echocardiographic and cardiac magnetic resonance parameters and the outcome at a follow-up of 61 months (range, 24-85 months) was determined.ResultsCompared with the healthy control group, the study group had significantly higher levels of TIMP1, PIIINP, CITP, PINP and NT-pro-BNP (p<0.05, each). The levels of PIIINP and CITP were significantly higher among patients with an SRV mass index above the mean value. The level of PIIINP was significantly higher among patients with an SRV EDV index above the mean value. CITP was significantly elevated in SRV late gadolinium enhanced (LGE) positive patients, compared to patients without SRV LGE. MMP9 and TIMP1 predicted an adverse clinical outcome on univariate Cox proportional hazard survival analysis in addition to well proven predictors of outcome (SRV EF and NYHA).ConclusionsWe demonstrated a pattern of altered collagen turnover adversely related with the indices of SRV remodeling and an adverse clinical outcome in patients with SRV.
| S-EPMC5540554 | biostudies-literature
Project description:BackgroundCongenitally corrected transposition of the great arteries (CCTGA) is a rare form of congenital heart disease which may present with sudden death from malignant arrhythmias including complete heart block and ventricular tachyarrhythmias as late complications. Only few cases about ventricular tachyarrhythmias, usually in those with markedly depressed systemic ventricular function, have been reported.Case summaryA 26-year-old woman with a known history of CCTGA presented to the emergency department with palpitations and breathlessness for 3-4 weeks and worsening symptoms for 8 h. She had a history of ventricular septal defect repair 14 years ago. Her initial presentation electrocardiogram demonstrated high degree atrioventricular block with a ventricular rate of 44 b.p.m. She had two episodes of complete syncope during this hospitalization, both required external defibrillation due to documented bradycardia-dependent ventricular fibrillations. Her two-dimensional echocardiography study confirmed the diagnosis of CCTGA with preserved systolic ventricular function. She underwent urgent temporal pacing wire placement with a paced ventricular rate at 90 b.p.m. Having thoroughly reviewed the arrhythmia events and discussed with the patient about the option of defibrillator vs. pacemaker therapy a decision was made upon her request for dual-chamber pacemaker implantation. She was discharged home uneventfully 3 days after hospital presentation and has been physically active at 3-, 6-, and 9-month follow-ups.DiscussionOur case illustrates the individualized clinical decision making in choosing device therapy for a rare congenital heart disease presented with malignant arrhythmia. Careful history taking, open communication, and closely planned long-term follow-up will be essential in caring for such patients.
| S-EPMC7042131 | biostudies-literature
Project description:BackgroundData on the use of circulating microRNAs (miRNAs) as biomarkers of cardiovascular diseases are emerging. Little, however, is known on the expression profile of circulating of microRNAs in congenital heart malformations with a systemic right ventricle that is prone to functional impairment. We aimed to test the hypothesis that circulating miRNA profile is altered in patients late after atrial switch operation for complete transposition of the great arteries (TGA) and further explored possible relationships between alteration of circulating miRNAs and systemic ventricular contractility.MethodsCirculating miRNA expression profiling of serum samples from 5 patients and 5 healthy controls was performed. The results were validated in 26 patients and 20 controls using real-time quantitative reverse-transcription polymerase chain reaction for candidate miRNAs with fold changes >3 by expression profiling. Systemic ventricular myocardial acceleration during isovolumic contraction (IVA) was determined by colour tissue Doppler echocardiography.ResultsCompared with controls, patients had significantly lower systemic ventricular IVA (p?=?0.002). Of the 23 upregulated miRNAs identified by profiling, 11 were validated to be increased in patients compared with controls: miR-16, miR-106a, miR-144*, miR-18a, miR-25, miR-451, miR-486-3p, miR-486-5p, miR-505*, let-7e and miR-93. Among the validated 11 miRNAs, miR-18a (r?=?-0.45, p?=?0.002) and miR-486-5p (r?=?-0.35, p?=?0.018) correlated negatively with systemic ventricular IVA for the whole cohort.ConclusionsA distinct serum miRNA expression signature exists in adults with complete TGA after atrial switch operation, with serum miR-18a and miR-486-5p being associated with systemic ventricular contractility.
| S-EPMC3847493 | biostudies-literature