Long-term myocardial performance of the systemic right ventricle during exercise in patients with transposition of the great arteries and atrial switch operation.

The most common clinical scenario in which RV is systemic, is dextroposition transposition of the great arteries (dTGA). This is the second most common cyanotic congenital heart disease [ 2 ]. Before the arterial switch operation was introduced in 1975 [ 3 ], patients with dTGA were treated with the Mustard or Senning procedure, also referred to as the atrial switch operation, where the systemic veins are routed to the subpulmonary morphological left ventricle and the pulmonary veins are routed to the systemic right ventricle [ 4 ].The atrial switch operation leaves the RV in a systemic position, leading to gradual RV dysfunction and RV failure [ 5 , 6 , 7 , 8 ]. In this context, sRV functional reserve and its ability to augment performance with exercise performance is not well studied.