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

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 associatedwith abnormal aortic bioelastic 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 GAand 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 groupswere comparable for age, sex, BSA, and office blood pressure values. In group GA aortic root was significantly dilated(27.4 +/- 7.5mm 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 cardiovascularmorbidity and mortality. (C) 2017 Elsevier B.V. All rights reserved.