Gothic aortic arch and cardiac mechanics in young patients after arterial switch operation for d-transposition of the great arteries

Abstract

Background In patients who have undergone arterial switch operation (ASO) for d-transposition of the great arteries a gothic aortic arch (GA) morphology has been found and it has been associated with abnormal aortic bio-elastic properties. Hypothesis GA is frequent in ASO patients and may have an impact on cardiac mechanics. Our study aims were to assess 1- the occurrence of GA in a large sample of patients after ASO; 2- the association between GA and aortic bio-elastic properties; and 3- the impact of GA on left ventricular (LV) function using speckle tracking echocardiography (STE). Methods We studied one hundred and five asymptomatic patients, who have undergone first stage ASO for d-TGA, with normal left ventricular ejection fraction (LVEF ≥ 53%). Results Forty-six (44%) patients showed a GA (mean age 11.5 ± 7.2 years, 26 males) while fifty-nine (56%) patients (mean age 9.6 ± 6.7 years, 37 males) did not present GA. The two groups were comparable for age, sex, BSA, and office blood pressure values. In group GA aortic root was significantly dilated (27.4 ± 7.5 mm vs. 21.2 ± 6.9 mm, p < 0.0001), aortic stiffness index (Group GA = 1.8 ± 1.2 vs. 1.4 ± 0.7, p = 0.025) was significantly increased, left atrial volume was larger (p = 0.0145), global longitudinal strain (Group GA = − 18.4 ± 2.5% vs. − 20.1 ± 3.3%, p = 0.012) and basal LV longitudinal strains (Group GA = − 16.9 ± 4.8% vs. − 20.4 ± 7.0%, p = 0.013) were significantly reduced. Conclusions After ASO the presence of a GA is associated with a significantly dilated aortic root, stiffer aortic wall, larger left atrial volume, and worse LV longitudinal systolic deformations, well known predictors of cardiovascular morbidity and mortality. © 2017 Elsevier B.V.