Long term ventricular performance after intra-atrial correction of transposition: left ventricular filling is the major limitation

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Abstract
Objective To establish the incidence of systolic and diastolic dysfunction of the right and left ventricle in a large cohort of patients after Mustard or Senning operations and to assess changes in the incidence on long term follow up. Design Postoperative case-control study using radionuclide ventriculography. Ejection fractions, peak filling rates, rapid filling periods and fractions, slow filling periods and fractions, and atrial contraction periods and fractions were studied. Setting Tertiary care centre, ambulatory and hospital inpatient care. Patients A convenience sample of 153 patients studied at median age of 6.9 years (median 4.4 years after surgery). In 99 cases another study was available at a median age of 15.3 years (median 13 years after surgery and 8.8 years after the first study). Results Respective incidences of dysfunction in the first and the second study were as follows: ejection fraction–right ventricle 7.8% and 8.1%, left ventricle 7.2% and 10.1%; peak filling rate–right ventricle 0% and 4.2%, left ventricle 14.3% and 29.5% (p < 0.05); rapid filling period– right ventricle 18.3% and 11.6%, left ventricle 30.2% and 30.5%; slow filling period—right ventricle 4.8% and 3.2%; left ventricle 11.9% and 23.2%;atrial contraction period–right ventricle 0.8% and 4.2%, left ventricle 15.1% and 26.3%; rapid filling fraction–right ventricle both 0%, left ventricle 82.5% and 79.0%; slow filling fraction–right ventricle 0.8% and 4.2%, left ventricle 37.3% and 30.5%; atrial contraction fraction–right ventricle both 0%, left ventricle 79.4% and 71.6%. Conclusions The incidence of systolic ventricular dysfunction is 8% (right ventricle) and 10% (left ventricle) 13 years after surgery, without a significant increase over the eight year follow up. Diastolic filling is abnormal in up to 80% of patients and left ventricular peak filling rate deteriorates with time.

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