Evaluation of exercise capacity long term after surgical correction of d-transposition of great arteries (d-TGA) by Senning atrial switch

  • Dr Artur Pietrucha, Coronary Disease Department, Medical School of Jagiellonian University, John Paul II Hospital, Cracow, Poland, Poland
  • Dr Beata Pietrucha, Children Cardiology Department, University Children Hospital Jagiellonian University, Cracow, Poland
  • Dr Nader El-Massri, Coronary Disease Department, Medical School of Jagiellonian University, John Paul II Hospital, Cracow, Poland, Poland
  • Dr Danuta Mroczek-Czernecka, Coronary Disease Department, Medical School of Jagiellonian University, John Paul II Hospital, Cracow, Poland, Poland
  • Dr Andrzej Gackowski, Coronary Disease Department, Medical School of Jagiellonian University, John Paul II Hospital, Cracow, Poland, Poland
  • Dr Ewa Konduracka, Coronary Disease Department, Medical School of Jagiellonian University, John Paul II Hospital, Cracow, Poland, Poland
  • Prof Andrzej Rudzinski, Children Cardiology Department, University Children Hospital Jagiellonian University, Cracow, Poland
  • Prof Wieslawa Piwowarska, Coronary Disease Department, Medical School of Jagiellonian University, John Paul II Hospital, Cracow, Poland, Poland

    • Aim of the study: evaluation exercise capacity in young people, long term after surgical correction of d-TGA by Senning atrial switch.
    We observed 21 pts (18 men, 3 women) at age 21-25 after Senning procedures, performed at 3-7 months of life.
    All pts underwent standard and 24-hour ECG , echocardiography examination, cardiac MRI and cardiopulmonary exercise treadmill test (ETT). Left (LV) and right ventricle (RV) function, ETT duration and workload, max oxygen uptake (VO2max) and anaerobic threshold (AT) were evaluated. VO2max, ETT work were also expressed as % of predicted values. Serum level of NT-proBNP was measured in all pts.
    Results: LV function was not reduced in all pts (LV diastolic diameter 46±4,2mm; LV EF 68±14,7%). RV dilatation (38,2±12,3mm with moderately reduced ejection fraction (RV EF 47±13,9%)were observed in pts after TGA correction. Cardiac MRI discovered significant RV dilatation with hypertorophy of RV walls with magnified trabeculation. Exercise was well tolerated by all pts. – they achieved about 100% of predicted workload (207,6±65,3W; 12±2,5METS). Value of VO2max was decreased in all pts. [24,3±9,1 ml/kg/min] - about 42,8% of predicted values. The level of AT was decreased in comparison to predicted values (0,97±0,12 l/min; 26,8±9,6 %VO2max). Serum level of NTproBNP was moderately increased (328±127,8 pg/ml).
    Conclusions.
    • Young people after surgical treatment of d-transposition of great arteries by Senning atrial switch revealed good exercise toleration.
    • In spite of good exercise toleration, mild to moderate reduction of exercise capacity and function of circulatory system was observed in these patients.