Abnormal Pulmonary Artery Bending Correlates With Increased Right Ventricular Afterload Following the Arterial Switch Operation

• Published in: World journal for pediatric & congenital heart surgery Vol. 10; no. 5; p. 572
• Main Authors: Loke, Yue-Hin, Capuano, Francesco, Mandell, Jason, Cross, Russell R, Cronin, Ileen, Mass, Paige, Balaras, Elias, Olivieri, Laura J
• Format: Journal Article
• Language: English
• Published: United States 01.09.2019
• Subjects: Adolescent; Arterial Switch Operation - adverse effects; Arterial Switch Operation - methods; Cardiac Catheterization; Child; Child, Preschool; Constriction, Pathologic; Echocardiography; Female; Heart Ventricles - physiopathology; Heart Ventricles - surgery; Hemodynamics; Humans; Lung; Male; Middle Aged; Postoperative Complications; Pulmonary Artery - abnormalities; Pulmonary Artery - surgery; Systole; Ventricular Function, Right; arterial switch; PA stenosis; pulmonary arteries; transposition of great arteries; cardiac magnetic resonance imaging (MRI); PA hemodynamics; curvature
• ISSN: 2150-136X
• DOI: 10.1177/2150135119861358

In transposition of great arteries, increased right ventricular (RV) afterload is observed following arterial switch operation (ASO), which is not always related to pulmonary artery (PA) stenosis. We hypothesize that abnormal PA bending from the Lecompte maneuver may affect RV afterload in the absence of stenosis. Thus, we sought to identify novel measurements of three-dimensional cardiac magnetic resonance (CMR) images of the pulmonary arteries and compare with conventional measurements in their ability to predict RV afterload. Conventional measurements and novel measurements of the pulmonary arteries were performed using CMR data from 42 ASO patients and 13 age-matched controls. Novel measurements included bending angle, normalized radius of curvature ( ), and normalized weighted radius of curvature ( ). Right ventricular systolic pressures (as the surrogate for RV afterload) were measured by either recent echocardiogram or cardiac catheterization. Conventional measurements of proximal PA size correlated with differential pulmonary blood flow ( = 0.49, = .001), but not with RV peak systolic pressures ( = -0.26, = .18). In ASO patients, correlated with higher RV systolic pressures ( = -0.57, = .002). Larger neoaortic areas and rightward bending angles correlated with smaller right pulmonary artery ( = -0.48, = .001; = 0.41, = .01, respectively). Finally, both pulmonary arteries had significantly smaller compared to normal controls. Pulmonary arteries exhibit abnormal bends following ASO that correlate with increased RV afterload, independent of PA stenosis. Future work should focus on clinical and hemodynamic contributions of these shape parameters.