Abstract
Despite their anatomical differences, congenitally corrected (ccTGA) and complete transposition of the great arteries (d-TGA) post-atrial switch are frequently studied together and managed similarly from a medical standpoint due to the shared systemic right ventricle (sRV). The aim was to assess differences in their underlying hemodynamics. The study is a retrospective review of 138 adults with ccTGA or d-TGA post-atrial switch undergoing cardiac catheterization at Mayo Clinic, MN between 2000 and 2021. ccTGA was categorized into isolated or complex ccTGA depending on concomitant ventricular septal defect and/or left ventricular outflow obstruction. There were 53 patients with d-TGA (91% post-Mustard procedure), 51 with complex and 34 with isolated ccTGA. Isolated ccTGA patients were older (51.8 ± 13.1 years) than those with d-TGA (37.5 ± 8.3 years) or complex ccTGA (40.8 ± 13.4 years). There were no differences in sRV or left ventricular size and function across groups. The ccTGA group more commonly had ≥ moderate tricuspid regurgitation than those with d-TGA; ≥ moderate mitral and ≥ moderate pulmonary regurgitation were most prevalent in complex ccTGA. There were no differences in sRV end-diastolic pressure (sRVEDP) or PAWP between groups. However, the ratio of PAWP:sRVEDP was higher in those with d-TGA compared to those with ccTGA. Cardiac index was higher in the d-TGA group than both groups of ccTGA patients with the latter showing higher indices of ventricular afterload. In conclusion, despite sharing a sRV, adults with d-TGA and ccTGA have substantial differences in hemodynamics and structural/valvular abnormalities. Further investigation regarding disease-specific responses to heart failure therapy in those with d-TGA and ccTGA is warranted.
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Abbreviations
- ccTGA:
-
Congenitally corrected transposition of the great arteries
- d-TGA:
-
Complete transposition of the great arteries
- PAWP:
-
Pulmonary artery wedge pressure
- PVR:
-
Pulmonary vascular resistance
- sRV:
-
Systemic right ventricle
- SVR:
-
Systemic vascular resistance
- TGA:
-
Transposition of the great arteries
- TR:
-
Tricuspid regurgitation
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WRM—study design, data abstraction/analysis, and drafting of the manuscript; CCJ, ACE, YND, JAD, DJH—critical review of the manuscript; HMC—data abstraction and critical review of the manuscript.
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Miranda, W.R., Jain, C.C., Egbe, A.C. et al. Hemodynamics in Adults with Systemic Right Ventricles: Differences Between Congenitally Corrected and Complete Transposition of the Great Arteries. Pediatr Cardiol (2024). https://doi.org/10.1007/s00246-023-03381-w
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DOI: https://doi.org/10.1007/s00246-023-03381-w