An Analysis of Left Ventricular Retraining in Patients With Dextro- and Levo- Transposition of the Great Arteries Richard D. Mainwaring, MD, William L.

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Presentation transcript:

An Analysis of Left Ventricular Retraining in Patients With Dextro- and Levo- Transposition of the Great Arteries Richard D. Mainwaring, MD, William L. Patrick, MD, Ali N. Ibrahimiye, MD, Naruhito Watanabe, MD, George K. Lui, MD, Frank L. Hanley, MD The Annals of Thoracic Surgery Volume 105, Issue 3, Pages 823-829 (March 2018) DOI: 10.1016/j.athoracsur.2017.11.047 Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 The progression of left ventricular (LV)/right ventricular (RV) pressure ratios is demonstrated for the 19 patients with levo-transposition of the great arteries who eventually underwent the double–switch operation. Ten patients had 1 pulmonary artery band (PAB), and 9 had 2 bandings. The overlay of the calculated retraining ratios is shown in red. The ratio was 0.87 for patients who required just 1 band and was 0.50 for patients who required 2 bands. The Annals of Thoracic Surgery 2018 105, 823-829DOI: (10.1016/j.athoracsur.2017.11.047) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 The progression of left ventricular (LV)/right ventricular (RV) pressure ratios is demonstrated for the 7 patients with levo-transposition of the great arteries who did not undergo a double–switch operation. The overlay of the calculated retraining ratios is shown in red. The ratio for the 3 patients who have had 1 pulmonary artery band (PAB) and were fully retrained was 0.88, and the ratio for the remaining 4 patients was 0.35. The Annals of Thoracic Surgery 2018 105, 823-829DOI: (10.1016/j.athoracsur.2017.11.047) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The progression of left ventricular (LV)/right ventricular (RV) pressure ratios is demonstrated for the 13 patients with dextro-transposition of the great arteries who underwent a late arterial switch. The overlay of the calculated retraining ratios is shown in red The ratio of the patients who required 1 pulmonary artery band (PAB) was 0.90, and the ratio for patients who needed multiple bands was 0.43. The Annals of Thoracic Surgery 2018 105, 823-829DOI: (10.1016/j.athoracsur.2017.11.047) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 The progression of left ventricular (LV)/right ventricular (RV) pressure ratios is shown for the 12 patients with dextro-transposition of the great arteries who failed to demonstrate adequate LV retraining after pulmonary artery banding (PAB). The overlay of the calculated retraining ratios is shown in red. The ratio for these patients was 0.31. The Annals of Thoracic Surgery 2018 105, 823-829DOI: (10.1016/j.athoracsur.2017.11.047) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Relationship between ratio of left ventricular (LV) retraining and success or failure of LV retraining. Retraining was uniformly successful in patients with a calculated ratio exceeding 0.40 and was uniformly unsuccessful when ratio was below 0.30. (D-TGA = dextro-transposition of the great arteries; L-TGA = levo-transposition of the great arteries.) The Annals of Thoracic Surgery 2018 105, 823-829DOI: (10.1016/j.athoracsur.2017.11.047) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 (A) Relationship between ratio of left ventricular (LV) retraining and presence or absence of heart failure at the time of enrollment. Patients with heart failure had significantly lower ratios as a group than patients who did not have heart failure. (B) Relationship between ratio of LV retraining and age of dextro (D)-transposition of the great arteries (TGA) and levo (L)-TGA patients at the time of enrollment. There was a poor correlation between ratio and age, as evidenced by an R2 = 0.2. The Annals of Thoracic Surgery 2018 105, 823-829DOI: (10.1016/j.athoracsur.2017.11.047) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions