TY - JOUR
T1 - Late gadolinium enhancement cardiovascular magnetic resonance of the systemic right ventricle in adults with previous atrial redirection surgery for transposition of the great arteries
AU - Babu-Narayan, Sonya V.
AU - Goktekin, Omer
AU - Moon, James C.
AU - Broberg, Craig S.
AU - Pantely, George A.
AU - Pennell, Dudley J.
AU - Gatzoulis, Michael A.
AU - Kilner, Philip J.
PY - 2005/4/26
Y1 - 2005/4/26
N2 - Background-Patients treated for transposition of the great arteries by atrial redirection surgery have a right ventricle (RV) that sustains systemic pressures long term. Late RV dysfunction occurs in these patients; the reasons for this are unclear, but myocardial fibrosis may be important. Myocardial fibrosis can be visualized by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR). We hypothesized that LGE would be present in the systemic RV and relate to adverse clinical features. Methods and Results-We performed CMR on 36 consecutive adult patients (mean age, 27 years) after atrial redirection surgery for transposition of the great arteries. Late gadolinium RV enhancement was seen in 22 patients (61%) with various patterns. Patients with RV LGE were older (30 versus 22 years; P<0.001) and had increased RV end-systolic volume index (43 versus 35 mL/m2; P=0.03), decreased RV ejection fraction (57% versus 62%; P=0.02), increased QRS duration (108 versus 97 ms; P=0.01), and increased QT dispersion (93 versus 71 ms; P=0.002). The extent of LGE correlated with age (r=0.59, P<0.001) and QRS duration (r=0.67, P<0.001) and inversely with RV ejection fraction (r=-0.76, P<0.001). The incidence of documented arrhythmia and/or syncope (10 of 36) was significantly higher in the late gadolinium-positive group (9/22 versus 1/14; P=0.03). Conclusions-LGE CMR suggestive of myocardial fibrosis occurs in the systemic RV of patients after atrial redirection, surgery. The extent of LGE correlates with age, ventricular dysfunction, electrophysiological parameters, and clinical events, suggesting prognostic importance that merits further investigation.
AB - Background-Patients treated for transposition of the great arteries by atrial redirection surgery have a right ventricle (RV) that sustains systemic pressures long term. Late RV dysfunction occurs in these patients; the reasons for this are unclear, but myocardial fibrosis may be important. Myocardial fibrosis can be visualized by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR). We hypothesized that LGE would be present in the systemic RV and relate to adverse clinical features. Methods and Results-We performed CMR on 36 consecutive adult patients (mean age, 27 years) after atrial redirection surgery for transposition of the great arteries. Late gadolinium RV enhancement was seen in 22 patients (61%) with various patterns. Patients with RV LGE were older (30 versus 22 years; P<0.001) and had increased RV end-systolic volume index (43 versus 35 mL/m2; P=0.03), decreased RV ejection fraction (57% versus 62%; P=0.02), increased QRS duration (108 versus 97 ms; P=0.01), and increased QT dispersion (93 versus 71 ms; P=0.002). The extent of LGE correlated with age (r=0.59, P<0.001) and QRS duration (r=0.67, P<0.001) and inversely with RV ejection fraction (r=-0.76, P<0.001). The incidence of documented arrhythmia and/or syncope (10 of 36) was significantly higher in the late gadolinium-positive group (9/22 versus 1/14; P=0.03). Conclusions-LGE CMR suggestive of myocardial fibrosis occurs in the systemic RV of patients after atrial redirection, surgery. The extent of LGE correlates with age, ventricular dysfunction, electrophysiological parameters, and clinical events, suggesting prognostic importance that merits further investigation.
KW - Fibrosis
KW - Heart defects, congenital
KW - Heart ventricles
KW - Magnetic resonance imaging
KW - Transposition of great vessels
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U2 - 10.1161/01.CIR.0000162463.61626.3B
DO - 10.1161/01.CIR.0000162463.61626.3B
M3 - Article
C2 - 15851616
AN - SCOPUS:17744395506
SN - 0009-7322
VL - 111
SP - 2091
EP - 2098
JO - Circulation
JF - Circulation
IS - 16
ER -