TITLE:
Noninvasive Assessment of Autonomic Cardiovascular Function in Patients after Arterial Switch Operation for Transposition of the Great Arteries
AUTHORS:
Joanna Hlebowicz, Maja Rooth, Sandra Lindstedt, Johan Holm, Ulf Thilén
KEYWORDS:
Congenital Heart Disease, Transposition of the Great Arteries, Arterial Switch Operation, Sympathetic Innervation
JOURNAL NAME:
Surgical Science,
Vol.6 No.3,
March
12,
2015
ABSTRACT: Background: Children born with
transposition of the great arteries (TGA) must undergo corrective surgery for
survival, arterial switch being the standard surgical procedure. The
sympathetic innervation of the heart may be damaged during the operation. This
study was designed to determine whether adults who were born with TGA and who
had arterial switch operation (ASO) in infancy exhibit denervation of the
heart, measured as heart rate variability (HRV) with electrocardiography (ECG).
Methods: Nine patients with transposition of the great arteries (four men and
five women; mean age 26 ± 1 years) who underwent the ASO at a mean age of 85 ±
35 days, and nine healthy adults (five men and five women; mean age 26 ± 2)
were included in the study. Cardiac autonomic nerve function was determined by
the variation in RR intervals during maximal deep breathing, monitored by
continuous ECG. The mean values were calculated for each group from six
inspirations (I) and expirations (E), and the E:I ratios were calculated.
Results: The E:I ratio did not differ between patients with an arterial switch
and healthy controls (P=
0.161). Two patients had signs of denervation of the heart up to 30 years after
the arterial switch operation. Conclusions: Reinnervation of the heartmay take place in patients who
have undergone the ASO in infancy, and these patients would not necessarily
suffer from autonomic dysfunction. The HRV, measured by ECG, has the potential
to identify arterially switched patients at risk of developing silent
myocardial ischemia.