Circulation, Vol 90, 1304-1309, Copyright © 1994 by American Heart Association
C Boutin, RA Jonas, SP Sanders, G Wernovsky, SM Mone and SD Colan
BACKGROUND: Banding of the pulmonary artery (PAB) in preparation for
arterial switch operation (ASO) in patients with transposition of the great
arteries (TGA) represents a unique model of acute left ventricular pressure
overload in humans. METHODS AND RESULTS: To establish the rate, magnitude,
and determinants of left ventricular hypertrophy and the acute effect on
ventricular function, serial bidimensional echocardiographic evaluations
were performed on 26 patients with TGA after PAB. Mass, volume, and
ejection fraction of the left ventricle were measured. Cardiac
catheterization data before PAB and again before ASO were reviewed. The
mean interval between the PAB and ASO was 9 +/- 4 days. The left
ventricular to right ventricular pressure ratio before PAB was 0.5 and
increased to 1.0 before ASO. The mean percentage increase in left
ventricular mass from PAB to ASO was 96%, 95% of which was achieved in the
first 7 days. The average rate of left ventricular hypertrophy for the
entire period was 0.06 g/h and was 0.19 g/h during the interval from PAB to
attainment of maximum left ventricular mass. The most rapid rate of
hypertrophy was seen by day 2, with an exponential fall in the growth rate
thereafter approaching zero by day 7. Ejection fraction was significantly
reduced at 12 hours after PAB, but mean values returned to pre-PAB levels
by 3.5 days after banding. The absolute rate of left ventricular
hypertrophy correlated directly with body surface area but not to other
hemodynamic variables. CONCLUSIONS: Doubling of left ventricular mass can
be achieved in 1 week after PAB. Function falls acutely due to afterload
excess and/or depressed contractility but recovers rapidly as compensatory
hypertrophy occurs.
ARTICLES
Rapid two-stage arterial switch operation. Acquisition of left ventricular mass after pulmonary artery banding in infants with transposition of the great arteries
Department of Pediatrics, Harvard Medical School, Boston, MA.
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