Impact of left ventricular function on early outcomes after arterial switch for D-transposition of great arteries with intact ventricular septum.

ABSTRACT

OBJECTIVE: The aim of this study was to assess the utility of tissue Doppler echocardiography in evaluating the pre-operative left ventricular systolic function and in turn its impact on early post-operative outcomes following arterial switch operation for transposition of great arteries with intact ventricular septum. BACKGROUND: Pre-operative left ventricular function is an important determinant of outcomes following arterial switch. METHODS: We studied 19 patients with transposition and intact septum who had undergone one stage arterial switch operation. All had a pre-operative echocardiogram. RESULTS: The left ventricle was adequate in 15 infants as per the dimensions and shape for age. The early outcomes of surgery were assessed on the basis of their pre operative tissue Doppler. There were 7 (40%) patients with reduced S wave velocities (2.62 +/- 0.84 cm/sec) and lower isovolumetric myocardial acceleration (1.2 +/- 0.5 m/sec(2)) reflecting systolic dysfunction. Those patients with reduced S wave velocities and isovolumetric acceleration correlated with poor early surgical outcomes in terms of longer duration of ventilation ( p< 0.001), longer duration of inotropes ( p< 0.00001) and higher mortality ( p < 0.001). CONCLUSION: The tissue Doppler echocardiography is a more sensitive modality to evaluate ventricular performance than the 2D-echo. It can be used as a sensitive predictor of outcomes following arterial switch.