Left ventricle function after arterial switch procedure for D-transposition of the great arteries: Long term evaluation by speckle-tracking analysis

Aim: The objective of this study was to assess left ventricle (LV) function in patients underwent arterial switch procedure (ASO) for transposition of great arteries (TGA) in long-term follow-up. Methods: We studied 59 asymptomatic patients (43 male) who have undergone single-stage ASO for TGA, aged 13.9 ± 4.8 years, with a normal LV ejection fraction, compared to healthy peers. We evaluated LV volume, function and myocardial deformation in asymptomatic patients with normal ejection fraction by using speckle-tracking echocardiography (STE). Results: Global longitudinal strain (GLS) was lower in patients compared to healthy peers throughout all age groups (5–9 years: −20.03 ± 0.65% vs 21.00 ± 1.30%, p = 0.083; 10–14 years: −19.43 ± 1.75% vs −21.80 ± 1.30%, p < 0.0001; 15–19 years: −19.05 ± 1.65% vs −22.50 ± 1.30%, p < 0.0001; 20–24 years: −17.90 ± 0.85% vs −20.90 ± 1.30%, p < 0.0001; >25 years: −18.60 ± 0.42% vs 20.60 ± 1.20%, p = 0.041). At the univariate analysis GLS resulted significantly related only to the presence of restrictive patent foramen ovale at birth (p = 0.0016). At the multivariate analysis GLS was significantly related to prenatal diagnosis, restrictive patent foramen ovale and by-pass time. Conclusion: Children and young adults late after ASO demonstrate normal ejection fraction, but present subclinical signs of myocardial dysfunction, such as reduction of longitudinal strain. Our findings support the usefulness of STE to detect it precociously.