Burkhardt Barbara Elisabeth Ursula, Kellenberger Christian Johannes, Franzoso Francesca Daniela, Geiger Julia, Oxenius Angela, Valsangiacomo Buechel Emanuela Regina
Department of Surgery, Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.
Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
Front Cardiovasc Med. 2019 Apr 9;6:39. doi: 10.3389/fcvm.2019.00039. eCollection 2019.
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. 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. Systemic right ventricular global longitudinal strain was decreased in patients compared to controls (-12.9 ± 3.3% vs. -18.9 ± 4.6%, < 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%, < 0.001). The systemic right ventricle, compared to the systemic left ventricle, showed decreased global longitudinal ( < 0.001) and circumferential strain ( < 0.001). The subpulmonary left ventricle, compared to the subpulmonary right ventricle, demonstrated similar longitudinal ( = 0.223) but higher circumferential strain ( < 0.001). 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.
接受大动脉转位心房调转术的成年幸存者，其形态学上的右心室呈体循环特征，形态学上的左心室呈肺循环特征。这种生理状态可被视为长期右心室压力超负荷及左心室后负荷降低影响的一个模型。我们旨在确定这些长期改变的负荷条件对心室心肌变形的影响。对29例心房修复术后患者（年龄29±7岁）和19例对照组患者（24±10岁；无显著差异）的二维稳态自由进动电影图像，使用特征跟踪软件（TomTec二维心肌运动分析）进行后处理。比较两组患者左右心室的容积、射血分数、整体及游离壁纵向和圆周应变。与对照组相比，患者体循环右心室的整体纵向应变降低（-12.9±3.3%对-18.9±4.6%，P<0.001），而右心室圆周应变无变化（-15.8±3.4%对-15.1±5%；无显著差异）。两组患者左心室纵向应变相似（-17±5.6%对-17.5±4.6%；无显著差异），但患者左心室整体圆周应变较低（-20.7±4.1%对-27.3±4.5%，P<0.001）。与体循环左心室相比，体循环右心室的整体纵向应变（P<0.001）和圆周应变（P<0.001）均降低。与肺循环右心室相比，肺循环左心室的纵向应变相似（P=0.223），但圆周应变较高（P<0.001）。在接受大动脉转位心房调转术修复的患者中，体循环右心室纵向应变较差，但右心室圆周应变保持正常。在体循环和肺循环位置，左心室的圆周应变均高于右心室。
