Three-dimensional speckle-tracking echocardiography-derived deformation analysis of the morphologic left ventricle in adults with corrected dextro-transposition of the great arteries-insights from the CSONGRAD Registry and MAGYAR-Path Study

Background: Dextro-transposition of the great arteries (dTGA) stands out as a prevalent cyanotic congenital heart defect (CHD), characterized by an intricate reversal in the arrangement of the major arteries. In the past, several surgical procedures have been used to treat dTGA, including the atrial switch. Although the method is no longer used, survivors of the procedure still living among us. Recent advancements in cardiovascular imaging have led to the emergence of several novel echocardiographic techniques, notably three-dimensional (3D) and/or speckle-tracking echocardiography (STE). The present study aimed to employ 3DSTE to determine morphologic left ventricle (mLV) strain parameters in adults with dTGA who underwent Senning or Mustard procedure at infancy. Furthermore, it was also aimed to assess whether the type of correction procedure had any impact on mLV deformation parameters. Methods: Eleven dTGA patients, with a mean age of 28.8 +/- 8.5 years (6 males, 6 Senning- and 5 Mustard-operated patients) were enrolled. They were compared to 34 healthy controls matched for age and gender (age: 35.7 +/- 12.8 years, 21 males). All subjects underwent complete two-dimensional (2D) Doppler echocardiography with 3DSTE data acquisition as per recent guidelines. Results: Comparing all dTGA patients to the control group no mean segmental or global mLV strains showed significant differences, however out of the regional strains, midventricular mLV longitudinal strain was significantly better (higher) in dTGA compared to the healthy group (-16.8%+/- 7.4% vs. -13.3%+/- 2.5%, P<0.05). The Mustard-operated patients showed significantly worse (lower) global mLV circumferential strain compared to that of controls (-22.1%+/- 12.4% vs. -28.9%+/- 4.7%, P=0.05). Out of the regional strains the Mustard procedure group had a significantly worse (lower) apical mLV circumferential strain (-24.8%+/- 11.9% vs. -35.6%+/- 9.0%, P=0.05), better (higher) midventricular mLV longitudinal strain (-20.1%+/- 9.2% vs. -13.3%+/- 2.5%, P=0.04) and a worse (lower) apical mLV area strain (-36.3%+/- 17.0% vs. -48.8%+/- 9.7%, P=0.03). Conclusions: Significant mLV strain abnormalities are present in dTGA late after atrial switch procedures. These differences are more pronounced in the Mustard-operated group.