Advanced echocardiography with strain imaging detected significantly reduced global and segmental right ventricular strain in Senning-repaired TGA patients compared with controls (P≤0.001).
Case-Control (n=41)
Does advanced echocardiography (strain and 3D) accurately assess systemic right ventricular function and correlate with cardiac MRI in patients with Senning-repaired D-TGA?
Advanced echocardiography with strain and 3D imaging is a valuable, practical tool that correlates well with CMR for detecting early systemic right ventricular dysfunction in patients with Senning-repaired D-TGA.
p-value: p=≤0.001
Background The Senning and Mustard atrial switch procedures were historically the standard repair for dextro-transposition of the great arteries (D-TGA), resulting in the morphologic right ventricle (RV) supporting the systemic circulation. Chronic systemic pressure loading leads to progressive RV dysfunction, impaired functional capacity, and eventual heart failure with increased morbidity and mortality. Although cardiac MRI (CMR) is the gold standard for assessing systemic RV function, its limited availability and technical challenges highlight the need for practical echocardiographic tools. Strain imaging and three-dimensional (3D) echocardiography may offer early markers of adverse outcomes. Patients and methods This prospective case–control study included 31 Senning-repaired TGA patients who underwent conventional echocardiography and CMR; 20 of them also underwent advanced echocardiography with strain and 3D RV assessment. Ten healthy children served as controls. Results Global and segmental RV strain values were significantly reduced in patients compared with controls ( P ≤0.001). RV end-diastolic volume index and end-systolic volume index were also markedly higher in the patient group ( P ≤0.001). Global RV ejection fraction (EF) was significantly lower in patients versus controls ( P ≤0.001). RV end-diastolic volume index, end-systolic volume index, and EF measured by 3D echo showed strong positive correlations with corresponding CMR parameters. Both patient subgroups − those with preserved and those with reduced 3D-derived EF − exhibited significantly impaired global longitudinal strain and segmental strain compared with controls ( P ≤0.001), indicating early myocardial deformation abnormalities even when EF is normal. Conclusions Autostrain-derived RV functional assessment is valuable for detecting early myocardial compromise in Senning-repaired TGA patients before EF decline. 3D echocardiography provides a practical bedside tool for ongoing evaluation of systemic RV volumetric and functional changes.
Hafez et al. (Thu,) conducted a case-control in dextro-transposition of the great arteries (D-TGA) following atrial switch surgery (n=41). Advanced echocardiography (strain and 3D RV assessment) vs. Healthy controls and Cardiac MRI (CMR) was evaluated on Global and segmental RV strain values (p=≤0.001). Advanced echocardiography with strain imaging detected significantly reduced global and segmental right ventricular strain in Senning-repaired TGA patients compared with controls (P≤0.001).