32 year follow up of patients following atrial redirection surgery for transposition of the great arteries |
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Authors: | M Louise Morrison Brian Grant Brian A McCrossan Andrew J Sands Colum G Owens Mark S Spence Frank A Casey Brian G Craig Christopher J Lockhart |
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Institution: | 1.Department of Paediatric Cardiology, The Royal Belfast Hospital for Sick Children, Belfast Health & Social Care Trust, Belfast, UK
2 Department of Adult Congenital Heart Disease, The Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, UK |
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Abstract: | Objective: A significant body of patients who have undergone Mustard or Senning
procedure require lifelong follow up. In this retrospective review, we examined the
cohort of such patients currently attending our center.
Design: Patients who had undergone either Mustard or Senning procedure were
identified. We retrospectively reviewed medical records, recorded demographic in‐
formation and data regarding the clinical state, NHYA class, cardiopulmonary exer‐
cise testing, NT‐proBNP measurement, and recent cardiac MRI findings.
Results: Forty‐six patients were identified, the mean age was 32.2 years (± 6.1 years),
67.4% were male. Thirty‐two patients (69.6%) had undergone a Senning procedure.
The median length of the follow‐up was 32 years. Thirty‐two patients (69.6%) were
NHYA class 1. The mean VO2max achieved was 24.2 ± 5.8 mL/min/kg. The mean NT‐
proBNP was 266.4 pg/mL (± 259.9 pg/mL). The mean right ventricular end‐diastolic
volume (RVEDV) was 212.4 mL ± 73.1 mL (indexed 114.2 mL/m2 ± 34.4 mL/m2
). The
mean right ventricular ejection fraction (RVEF) was 53.7% ± 7.9%. The mean left ven‐
tricular end‐diastolic volume (LVEDV) was 161.5 mL ± 73.7 mL (indexed 87.8 mL/
m2 ± 41.1 mL/m2
). The mean left ventricular ejection fraction (LVEF) was 59.8% ±
5.7%. There was a significant correlation between right ventricular (RV) size on MRI
and NT‐proBNP level.
Conclusions: We present a relatively well cohort of patients with overall favorable
long‐term outcome. The majority of patients are NHYA class 1 and the systemic right
ventricular function appears to be well preserved as assessed by MRI. The exercise
tolerance is reduced, with the majority of patients achieving around 60% of the esti‐
mated VO2max. Regular specialist follow‐up and assessment with advanced imaging at
regular intervals remain important for this group. |
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Keywords: | adult congenital heart disease Mustard procedure outcome Senning procedure transposition |
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