Joosen Renée S, van de Veerdonk Marielle C, Bohte Anneloes E, Takken Tim, van Wijk Abraham, Dickinson Michael G, Krings Gregor J, Voskuil Michiel, Breur Johannes M P J
Department of Pediatric Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Cardiology, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, the Netherlands.
J Cardiovasc Magn Reson. 2025;27(1):101899. doi: 10.1016/j.jocmr.2025.101899. Epub 2025 Apr 24.
Right ventricular (RV) function and exercise capacity predict prognosis in transposition of the great arteries (TGA) after arterial switch operation (ASO). We aim to longitudinally evaluate RV dimensions, global function and exercise capacity after ASO, comparing patients with and without RV pressure overload.
This retrospective study included TGA patients post-ASO with two cardiovascular magnetic resonance (CMRs) examinations at the University Medical Center Utrecht between 2004 and March 2024. Cardiac volumes, function, strain, and vessel dimensions were measured. Patients were categorized by RV pressure overload. Repeated exercise tests were performed in a subset. The first and second CMR were compared.
The cohort (111 patients, 22±8years; 71% male (79/111)) underwent the first CMR at median 13 [11-19] years post-ASO (mid-term follow-up) and the second at 21 [16-26] years post-ASO (long-term follow-up). RV volumes, function, and strain remained stable during long-term follow-up. Aortic root dimensions showed no progression during long-term follow-up (diameter: 23±5 mm/m² vs. 20±4 mm/m², p<0.001). 50% (56/111) underwent exercise testing, revealing a VO2peak decline, with 25% (14/56) having reduced VO2peak at mid-term follow-up and 46% (26/56) at long-term follow-up (mean age 21±7years) (p=0.012). This was not related to peak heart rate or chronotropic index (peakHR: R=0.115, p=0.413; chronotropic index: R=0.099, p=0.484). No differences were observed between patients with and without RV pressure overload.
Long-term exercise capacity is impaired in a significant portion of TGA patients. RV volumes, global function, strain, and aortic root dimensions remained unchanged during long-term follow-up post-ASO.
在大动脉转位（TGA）患者接受动脉调转手术（ASO）后，右心室（RV）功能和运动能力可预测预后。我们旨在纵向评估ASO术后RV的大小、整体功能和运动能力，并比较有无RV压力超负荷的患者。
这项回顾性研究纳入了2004年至2024年3月期间在乌得勒支大学医学中心接受两次心血管磁共振（CMR）检查的TGA患者，ASO术后。测量心脏容积、功能、应变和血管大小。患者按RV压力超负荷进行分类。对一部分患者进行了重复运动测试。比较了第一次和第二次CMR检查结果。
该队列（111例患者，年龄22±8岁；71%为男性（79/111））在ASO术后中位时间13[11 - 19]年（中期随访）接受了第一次CMR检查，在ASO术后21[16 - 26]年（长期随访）接受了第二次CMR检查。在长期随访期间，RV容积、功能和应变保持稳定。主动脉根部尺寸在长期随访期间无进展（直径：23±5mm/m²对20±4mm/m²，p<0.001）。50%（56/111）的患者进行了运动测试，结果显示峰值摄氧量下降，其中25%（14/56）在中期随访时峰值摄氧量降低，46%（26/56）在长期随访时（平均年龄21±7岁）降低（p = 0.012）。这与峰值心率或变时指数无关（峰值心率：R = 0.115，p = 0.413；变时指数：R = 0.099，p = 0.484）。有无RV压力超负荷的患者之间未观察到差异。
相当一部分TGA患者的长期运动能力受损。在ASO术后的长期随访中，RV容积、整体功能、应变和主动脉根部尺寸保持不变。
