The mitral annulus in transposition of the great arteries late after Senning- and Mustard-procedures (Insights from the CSONGRAD Registry and MAGYAR-Path Study)

BACKGROUND: Dextro-transposition of the great arteries (dTGA) is a rare condition comprising 5–7% of all congenital heart diseases (CHD). Until 1990s, atrial switch operations were the method of choice for the treatment of dTGA. The aim of our present study was to evaluate the abnormalities of the mitral annulus (MA) by three-dimensional speckle-tracking echocardiography (3DSTE). Potential differences in MA dimensions and functional properties late after Senning- and Mustard-procedures were analyzed as well. METHODS: This retrospective cohort study comprised 19 dTGA patients late after atrial switch operation, from which 7 subjects were not involved due to inferior image quality. The remaining dTGA patient group comprised 12 subjects (age: 30.7±8.6 years, 7 males). For comparisons, 32 age- and gender-matched healthy controls were evaluated (age: 34.4±12.3 years, 18 males). RESULTS: End-systolic and end-diastolic MA diameter (MAD), area and perimeter proved to be increased, while MA functional parameters [MA fractional area change (MAFAC) and fractional shortening (MAFS)] were reduced in all dTGA patients as compared to matched controls regardless of the atrial switch procedure used. However, MA morphological parameters were tendentiously lower, while MA functional parameters were tendentiously favorable in case of Senning-procedure compared to Mustard-procedure. CONCLUSIONS: dTGA is accompanied by MA dilation and its functional impairment late after Senning- and Mustard-procedures.