Key result
Neoaortic insufficiency was present in 75% of patients long term after an arterial switch operation and was significantly correlated with larger neoaortic valve and aortic sinus diameters, but not with the surgical technique used.
Why the study?
Neoaortic regurgitation and root dilatation commonly occur after an arterial switch operation for transposition, prompting evaluation of their long-term relation to root diameters, surgical technique, and multimodality imaging agreement.
Cohort (n=56)
No
Long-term after an arterial switch operation, neoaortic root dilatation correlates with neoaortic insufficiency, though most cases remain competent, and echocardiography may overestimate regurgitation severity compared to MRI.
Supports surveillance of neoaortic dimensions after arterial switch; leaves open whether diameter-targeted interventions alter insufficiency progression.
Neoaortic regurgitation and root dilatation are common findings in patients with transposition after an arterial switch operation. The aim of this study was to describe the relation between neoaortic regurgitation long term after an arterial switch procedure, aortic root diameters, and surgical technique used. We also assessed the agreement of the neoaortic regurgitation grade and root diameters in different imaging modalities. For this retrospective study, we qualified 56 consecutive patients who, according to our institutional protocol, had a routine postoperative evaluation of more than 16 years with multimodality imaging studies. Neoaortic regurgitation was assessed by both transthoracic echocardiography and magnetic resonance imaging, and the root diameters obtained by echocardiography and tomography were compared to the reference values and associated with the presence of neoaortic insufficiency. Neoaortic insufficiency was present in 75% of examined patients; the vast majority of them had trace or mild regurgitation, and its qualitative evaluation was significantly different between echocardiography and magnetic resonance imaging. In our study group, the neoaortic valve and aortic sinus were larger in relation to the normal values, and they were significantly correlated with the presence of neoaortic insufficiency, but not with the surgical technique used. Values obtained by echocardiography and tomography correlated well but were significantly different. Transthoracic echocardiography has a tendency to overestimate the severity of regurgitation compared to magnetic resonance imaging. Neoaortic valve and sinus dilatation are significantly correlated with valve insufficiency, but in most cases of root dilatation, the valve remains competent.
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Michalak et al. (2019) conducted a cohort in Transposition of the great arteries after arterial switch operation (n=56). Arterial switch operation was evaluated on Prevalence of neoaortic insufficiency by transthoracic echocardiography. Neoaortic insufficiency was present in 75% of patients long term after an arterial switch operation and was significantly correlated with larger neoaortic valve and aortic sinus diameters, but not with the surgical technique used.
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