ABSTRACT
BACKGROUND: Transposition of the great arteries (TGA) after atrial switch operation and congenitally corrected TGA (ccTGA) are commonly associated with impaired systemic right ventricular (RV) function and impaired prognosis. We aimed to investigate the value of indices of myocardial deformation on speckle-tracking echocardiography for quantifying ventricular function and their potential role in assessing ventricular-ventricular interaction and outcome in patients with a systemic RV. METHODS AND RESULTS: A total of 129 patients (87 with TGA and atrial switch and 42 with ccTGA, 71 men, age 35 ± 12 years) were investigated, and biventricular myocardial deformation was compared with findings in healthy subjects (n = 38, age 36 ± 10 years). Systemic ventricular longitudinal 2-dimensional (2D) peak systolic strain (RV 2D-LS) was significantly reduced compared with controls (-12.9 ± 3.6 and -15.4 ± 5.1 vs -21.0 ± 5.5 in TGAs, ccTGAs, and controls, P < .0001). Systemic and pulmonary 2D-LS were correlated in patients with TGA (r = 0.46, P < .0001) and ccTGA (r = 0.64, P < .0001), suggesting interventricular interaction, and this was confirmed when ejection fraction on magnetic resonance imaging was assessed (r = 0.53, P < .0001). More importantly, systemic 2D-LS (hazard ratio 1.31, P = .01) was related to adverse clinical outcome (symptomatic progression to New York Heart Association class ≥3, clinically relevant cardiac arrhythmia, or death) in patients with TGA and atrial switch independently of ejection fraction on cardiac magnetic resonance imaging, history of clinically relevant arrhythmia, or functional class. CONCLUSIONS: Global longitudinal systolic strain is significantly reduced in patients with a systemic RV, is related to subpulmonary ventricular function, and predicts adverse clinical outcome in adults with atrial switch TGA.
Subject(s)
Stroke Volume/physiology , Transposition of Great Vessels/physiopathology , Transposition of Great Vessels/surgery , Ventricular Dysfunction, Right/diagnostic imaging , Ventricular Dysfunction, Right/physiopathology , Adult , Age Factors , Analysis of Variance , Cardiac Surgical Procedures/methods , Case-Control Studies , Congenitally Corrected Transposition of the Great Arteries , Echocardiography, Doppler/methods , Female , Humans , Linear Models , Male , Middle Aged , Multivariate Analysis , Myocardial Contraction/physiology , Predictive Value of Tests , Prognosis , Proportional Hazards Models , Pulmonary Artery , ROC Curve , Retrospective Studies , Risk Assessment , Severity of Illness Index , Sex Factors , Stress, Physiological , Survival Rate , Systole , Transposition of Great Vessels/diagnostic imaging , Transposition of Great Vessels/mortality , Ventricular Dysfunction, Right/mortality , Ventricular Function/physiology , Young AdultABSTRACT
In this report we highlight the use of PET scan in plastic and reconstructive surgery. PET scanning is a very important tool in plastic surgery oncology (melanoma, soft-tissue sarcomas and bone sarcomas, head and neck cancer, peripheral nerve sheath tumors of the extremities and breast cancer after breast esthetic surgery), as diagnosis, staging, treatment planning and follow-up of cancer patients is based on imaging. PET scanning seems also to be useful as a flap monitoring system as well as an infection's imaging tool, for example in the management of diabetic foot ulcer. PET also contributes to the understanding of pathophysiology of keloids which remain a therapeutic challenge.
