Combined pressure and volume loading for left ventricular training in patients with congenitally corrected transposition of the great arteriesCentral MessagePerspective
Antonia Schulz, MD,
Marcus Kelm, MD,
Viktoria H.M. Weixler, MD, PhD,
Peter Kramer, MD,
Mi-Young Cho, MD,
Stanislav Ovroutski, MD,
Felix Berger, MD,
Joachim Photiadis, MD
Affiliations
Antonia Schulz, MD
Department of Congenital and Pediatric Heart Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany; Address for reprints: Antonia Schulz, MD, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany.
Marcus Kelm, MD
Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany; Department of Congenital Heart Disease – Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany
Viktoria H.M. Weixler, MD, PhD
Department of Congenital and Pediatric Heart Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
Peter Kramer, MD
Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Congenital Heart Disease – Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany
Mi-Young Cho, MD
Department of Congenital and Pediatric Heart Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Stanislav Ovroutski, MD
Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Congenital Heart Disease – Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany
Felix Berger, MD
Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany; Department of Congenital Heart Disease – Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany
Joachim Photiadis, MD
Department of Congenital and Pediatric Heart Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Objective: Patients with congenitally corrected transposition of the great arteries may require left ventricular training before the double switch operation. We evaluated the effects of combined pressure and volume loading. Methods: We performed a retrospective study of patients with congenitally corrected transposition of the great arteries who underwent left ventricular training between 2012 and 2022. Results: Fifteen patients underwent left ventricular training at a median age of 1.5 years (interquartile range [IQR], 0.7-5.6). Their median left ventricular mass index was 21 g/m2 (IQR, 18.9-36.6), left ventricular end-diastolic volume index was 65.1 mL/m2 (IQR, 40.6-84.6), and systolic left ventricular/right ventricular pressure ratio was 0.35 (IQR, 0.31-0.5). In addition to pulmonary artery banding, atrial septectomy was performed in 12 patients (80%). Two patients already had a relevant shunt. One patient required systemic ventricular assist device implantation and heart transplantation. After a median of 1.9 years (IQR, 0.8-4.4), left ventricular mass index had increased to 38.5 g/m2 (IQR, 25-49, P = .002), left ventricular end-diastolic volume index to 71.4 mL/m2 (IQR, 50.1-94.4, P = .13), and systolic left ventricular/right ventricular pressure ratio to 0.94 (IQR, 0.84-1.1, P = .002). Older patients demonstrated a lower increase in left ventricular pressure. Six patients (6/14, 43%) have met eligibility criteria for the double switch operation (5 performed). Their age at the time of pulmonary artery banding was 1.7 years (IQR, 0.5-3.7), and the time between pulmonary artery banding and double switch operation was 3.1 years (IQR, 1.5-5.2). One patient required double switch operation takedown due to left ventricular failure. Two older patients were considered nonresponders to left ventricular training. Conclusions: Combined pressure and volume loading resulted in a significant increase in left ventricular mass index and left ventricular pressure. Among older patients, there were nonresponders who remained not suitable for the double switch operation.
