Left ventricular systolic and diastolic function after two-stage anatomic correction of transposition of the great arteries

Anatomic repair of transposition of the great arteries (TGA) has been developed because of concerns about right ventricular function after atrial repair by the Mustard or the Senning technique. This study assessed left ventricular systolic and diastolic function in three patients after two-stage anatomic repair. Two patients had a ventricular septal defect (one with coarctation), and the third patient had right ventricular dysfunction precluding atrial repair. All had pulmonary artery banding. The mean ages at the time of repair and catheterization were 2.75 and 4.9 years, respectively. The control group included 10 patients with insignificant or no cardiac disease. At cardiac catheterization the group with TGA had a higher mean end-diastolic volume index (110.9 ± 4.74 ml/m 2) compared to normal subjects (79.1 ± 14.55; p < 0.001), mean end-systolic volume index (37.3 ± 3.69 vs 22.7 ± 4.42; p < 0.001), mass index (101.0 ± 16.9 vs 68.2 ± 12.34; p = 0.038), and stroke volume index (73.6 ± 3.52 vs 56.5 ± 12.1; p = 0.0027). The ejection fractions, end-diastolic and peak systolic pressures, and stresses were not different. There was no difference in the relationship between the mean rate-corrected velocity of circumferential fiber shortening and end-systolic stress for the group with TGA, but myocardial stiffness was markedly elevated (29.5 ± 1.84 vs 10.8 ± 2.20; p < 0.001). Thus, this study found abnormalities of left ventricular size after two-stage anatomic repair of TGA in this group of patients with TGA. Contractile function was within normal limits, but at the lower end of normal, and myocardial stiffness was increased.