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Patients with congenitally corrected transposition of the great arteries (CCTGA) often develop systemic right ventricular (SRV) dysfunction and systemic tricuspid regurgitation (TR). Studies using echocardiography have suggested a relationship between the degree of TR and SRV dysfunction. However, the geometry of the SRV limits the quantitative assessment of the SRV by echocardiography. Cardiac MRI (CMR) has become the gold standard for volumetric assessment of the SRV. We sought to determine whether there is a relationship between degree of TR and SRV function by CMR.
We performed a retrospective cohort study evaluating all patients (age ≥18 years) with CCTGA seen at our Adult Congenital Heart Disease Center who underwent CMR between 1/1999 and 11/2012. Patients with tricuspid valve surgery prior to CMR were excluded. TR was quantified by transthoracic echocardiography. A blinded reader reviewed ventricular size, function and mass by CMR for each patient.
Of the 30 patients (37% male), 11 had ≤mild TR (37%) and 19 had ≥moderate TR (63%). Mean age at CMR was 38 years (23-64) and 11 (37%) had associated congenital lesions. Mean SRV ejection fraction for patients with ≥ moderate TR was not significantly different than patients with ≤mild TR (45% vs. 42%, p=0.34). Mean indexed right ventricular end diastolic volume was also not significantly different (128 ml/m2 vs. 130 ml/m2, p = 0.85). Patients with ≥moderate TR were more likely to report dyspnea (46% vs. 0%, p=0.02). However, ≥ moderate TR was not associated with additional congenital lesions, arrhythmias or decreased left ventricular function by CMR.
In our cohort of patients with CCTGA there was no association between degree of TR and SRV volume or ejection fraction by CMR. Failure to show worsening SRV function or increased volume with greater degrees of TR suggests that degree of TR alone may not fully explain the heterogeneity in SRV function amongst patients with CCTGA.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Congenital Cardiology Solutions: Valvular Disease in the Adult
Abstract Category: 12. Congenital Cardiology Solutions: Adult
Presentation Number: 1202-115
- 2013 American College of Cardiology Foundation