D Woodrow Benson

Janaka P Wansapura

Kan N Hor

Karen Smith

Robert J Fleck

William M Gottliebson

Wojciech Mazur

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BioMed Central
Journal of Cardiovascular Magnetic 
Resonance
ssOpen AccePoster presentation
Cardiac mri strain analysis demonstrates systemic right 
ventricular dysfunction late after atrial switch procedure despite 
normal ejection fraction
Karen Smith1, Kan N Hor1, Wojciech Mazur2, Janaka P Wansapura1, 
Robert J Fleck1, D Woodrow Benson1 and William M Gottliebson*1
Address: 1Cincinnati Children's Hospital, Cincinnati, OH, USA and 2Ohio Heart and Vascular Center, Cincinnati, OH, USA
* Corresponding author    
Introduction
The atrial switch operation (ASO), performed routinely
until the early 1990's for d-Transposition of the Great
Arteries (d-TGA), resulted in a systemic right ventricle
(SRV). Anecdotal qualitative data has suggested that the
RV is doomed to progressive dysfunction and eventual
systolic failure when placed in the systemic circulation
over the long term. Quantitative analysis of SRV function
after ASO has only recently been available via cardiac MRI
(CMR) assessment of SRV Ejection Fraction (EF), an index
that has proven to be somewhat insensitive to subtle car-
diac dysfunction in other cardiac conditions. We hypoth-
esized that CMR-based myocardial strain (ε) assessment
would prove a more sensitive indicator of cardiac dysfunc-
tion than SRV EF in ASO subjects.
Purpose
Determine the changes in myocardial strain in a cross sec-
tion of ASO patients.
Methods
Data was reviewed from d-TGA ASO subjects and normal
young-adult control subjects, all of whom underwent
CMR at our center for clinical or research indications.
Data included demographics and systemic ventricular EF
via standard techniques. Systemic ventricular circumfer-
ential strain (εcc) was measured with feature tracking soft-
ware (Diogenes®, TomTEC Inc, Munich, Germany). The
ASO subjects also had radial (εrr), and longitudingal (εll)
SRV strains measured, and these subjects were further
stratified into global functional classes by SRV EF as nor-
mal (>55%) or depressed (< 55%). Statistical compari-
sons were performed between SRV EF and ε, as well as age/
time since surgery, via student's t-tests.
Results
Data from 33 ASO subjects and 14 controls was analyzed.
Mean SRV εcc magnitude for all post ASO subjects was
lower than systemic ventricular εcc magnitude in controls,
regardless of EF status, and was lower still for ASO subjects
with abnormal SRV EF (see Table 1 for further details).
However, there was no significant correlation between
time since ASO and SRV EF or SRV εcc magnitude (r2 = 0.02
and 0.14) (Figure 1 a-b). In addition, neither εll nor εrr
strain indexes were significantly different between ASO
classes.
Conclusion
In ASO patients with normal EF, SRV εcc magnitude is
decreased compared with systemic ventricular εcc in con-
trols. SRV εcc magnitude is further depressed in ASO
patients with abnormal SRV EF. However, SRV systolic
function, as measured by both EF and ε, was not associ-
ated with time since ASO. This data suggests that as a more
sensitive indicator of SRV function, SRV εcc surveillance
should be included routinely as a parameter of SRV func-
tional assessment.
from 13th Annual SCMR Scientific Sessions
Phoenix, AZ, USA. 21-24 January 2010
Published: 21 January 2010
Journal of Cardiovascular Magnetic Resonance 2010, 12(Suppl 1):P24 doi:10.1186/1532-429X-12-S1-P24
<supplement> <title> <p>Abstracts of the 13<sup>th </sup>Annual SCMR Scientific Sessions - 2010</p> </title> <note>Meeting abstracts - A single PDF containing all abstracts in this Supplement is available <a href="http://www.biomedcentral.com/content/files/pdf/1532-429X-11-S1-full.pdf">here</a>.</note> <url>http://www.biomedcentral.com/content/files/pdf/1532-429X-11-S1-info</url> </supplement>
This abstract is available from: http://jcmr-online.com/content/12/S1/P24
© 2010 Smith et al; licensee BioMed Central Ltd. Page 1 of 2
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Table 1: Comparison of CMR findings between control and ASO groups
Groups Parameters Controls (n = 14) ASO normal SRV EF (n-13) ASO low SRV EF (n = 20)
Age (years) 17.3 ± 8.4 22.1 ± 6.1 23.6 ± 6.3
Heart rate (bbm) 73 ± 14 66 ± 13 70 ± 12
Age at ASO (mo) - 17 ± 15 22 ± 16
EF (%) 63.8 ± 3.0 60.7 ± 6.1 47.2 ± 7.4*
Ecc -18.3 ± 1.6 -10.9 ± 2.2* -9.1 ± 2.7*
Err - 9.0 ± 3.9 9.9 ± 4.8
Ell - -10.6 ± 2.0 -8.5 ± 4.0
(a) There is no siginificant correlation between time since arterial switch operation (ASO) and systemic right ventricular (SRV) ejection fracti n (EF)Figur  1
(a) There is no siginificant correlation between time since arterial switch operation (ASO) and systemic right 
ventricular (SRV) ejection fraction (EF). r2 = 0.02. (b) nor is there a significant correlation between time since ASO and 
SRV circumferential strain (Ecc) (r2 = 0.14).Page 2 of 2
(page number not for citation purposes)


Cardiac mri strain analysis demonstrates systemic right ventricular dysfunction late after atrial switch procedure despite normal ejection fraction

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Cardiac mri strain analysis demonstrates systemic right ventricular dysfunction late after atrial switch procedure despite normal ejection fraction

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