Left ventricular remodelling in long-term survivors after the arterial switch operation for transposition of the great arteries

Abstract

The arterial switch operation (ASO) is the standard surgical procedure for transposition of the great arteries (TGA).1-4 Its operative mortality is low and long-term outcomes are generally excellent,1-3 although ventricular dysfunction is a recognized complication.1-4 The ASO involves a surgical transfer of coronary arteries from the aorta to the neoaorta and results in nonanatomical positioning of the proximal coronary arteries.3 The long-term integrity of the coronary artery circulation is uncertain and current guidelines recommend evaluation for coronary patency and function at least once during adulthood with non-invasive ischaemia testing and every 3-5 years in adult survivors of the ASO.1,3 While systolic and diastolic function are thought to be generally preserved in patients after the ASO, acute myocardial ischaemia at the time of surgery or chronic hypoperfusion related to the altered coronary anatomy may result in fibrotic myocardial remodelling,5 with myocardial dysfunction.3 Cardiac magnetic resonance (CMR) allows for the evaluation of myocardial perfusion,4 detection of discrete myocardial scarring by late gadolinium enhancement (LGE), and quantification of diffuse fibrosis by native T1 times and extracellular volume fraction (ECV).5 The aim of this study was to study myocardial and ventricular health in paediatric survivors after the ASO.