Changes in Left Ventricular Dimensions after Pulmonary Artery Banding and Jatene Operation in Children with Complete Transposition of the Great Arteries Echocardiography Study

Abstract

Echocardiographic left ventricular (LV) dimensions in patients with complete transposition of the great arteries (TGA's) were measured before and after the Jatene procedure and/or pulmonary artery banding (PAJB). The LV posterior wall thickness at end-diastole (LVPWTD) increased from 3.5±0.4 to 4.9±0.9mm (mean±SD) (p<0.01) after PAB, but it did not show a significant change following the Jatene procedure (from 4.5 ± 1.0 to 5.3±0.8 mm). The LV end-diastolic internal dimension (LVIDD) increased from 17.7±4.0 to 22.6 ± 6.5 mm after PAB (p<0.01), but remained unchanged after the Jatene procedure (from 24.5 ± 5.0 to 25.0 ± 3.0 mm). The LV shortening fraction (LVSF) decreased from 0.62±0.10 to 0.47±0.14 after PAB (p<0.01), but remained unchanged after the Jatene procedure (0.40±0.10 to 0.37±0.10). The a/b ratio at end-systole: (a/b)s, which indicates the flatness of the LV configuration, increased from 0.27±0.14 to 0.60±0.21 after PAB (p<0.01) and from 0.61±0.13 to 0.74±0.17 after the Jatene procedure (p<0.01). The data obtained became stable 1 month after operation. One patient died of low cardiac output with no evidence of myocardial infarction after the Jatene procedure. In this patient, LVPWTD was 5.7 mm, LVIDD was 26 mm, LVSF was 0.71 and the (a/b)s ratio was 0.55. In conclusion, PAB effectively increases LV wall thickness 1 month after operation, and echocardiographic prerequisites for the Jatene procedure were LVPWTD>4.0 mm, (a/b)s ratio>0.5, and LVSF between 0.2 and 0.56 in patients younger than 16 months. © 1988, International Heart Journal Association. All rights reserved.