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Exercise Capacity After Arterial Switch Operation in Patients with D-Transposition of Great Arteries: Does the Coronary Artery Anatomy Matter?

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Abstract

Variant coronary anatomy (VarCA) is frequent in D-Transposition of the great arteries (d-TGA). There are a paucity of data on the effect of the VarCA on the exercise capacity (XC) in patients with repaired d-TGA. This retrospective study included patients with d-TGA who underwent an arterial switch operation (ASO) and had at least one cardiopulmonary exercise test (CPET). Data from the treadmill CPET and simultaneously performed spirometry were collected. The parameters of CPET were compared between patients with usual anatomy vs. VarCA. Longitudinal changes in XC in patients with ASO were also analyzed. A total of 44 patients with either usual coronary anatomy (n = 27, 61%) or VarCA (n = 17, 39%) met inclusion criteria. There was no significant difference in oxygen consumption (%VO2) at initial CPET (104 vs. 100%, p = 0.53) between the two groups. Abnormal %VO2 (< 85%) was uncommon in both groups (n = 2, 7.4% vs. n = 4; 23.5%; p = ns). For longitudinal changes, there was no significant decline in %VO2 in either group: (i) usual coronary anatomy (n = 15, median follow-up 4.8 years, %VO2 111 vs. 108%; p = 0.306) and (ii) VarCA (n = 10, median follow-up 6.6 years, %VO2 106 vs. 92%; p = 0.441). Spirometry was abnormal in 25 (59.5%) patients [restrictive (n = 8, 19.0%), obstructive (n = 15, 35.7%), and mixed (n = 2, 4.8%)] butabnormal spirometry had no impact on the XC. Patients with d-TGA who underwent neonatal ASO uniformly exhibited good XC without any longitudinal decline on medium-term follow-up, regardless of coronary artery anatomy. Although frequent (60%), abnormal spirometry was not associated with reduced exercise capacity.

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Authors and Affiliations

  1. Department of Pediatrics, Children’s Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, MI, 48201, USA

    Daiji Takajo

  2. Division of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI, USA

    Chenni S. Sriram, Deemah Mahadin & Sanjeev Aggarwal

Authors
  1. Daiji Takajo
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  2. Chenni S. Sriram
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  3. Deemah Mahadin
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  4. Sanjeev Aggarwal
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Contributions

DT and SA conceptualized and designed the study, designed the data collection instruments, collected data, drafted the initial manuscript, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Daiji Takajo.

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The authors declare that they have no conflict of interest.

Ethical Approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Wayne State University approved this study.

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Takajo, D., Sriram, C.S., Mahadin, D. et al. Exercise Capacity After Arterial Switch Operation in Patients with D-Transposition of Great Arteries: Does the Coronary Artery Anatomy Matter?. Pediatr Cardiol 43, 1752–1760 (2022). https://doi.org/10.1007/s00246-022-02912-1

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  • DOI: https://doi.org/10.1007/s00246-022-02912-1

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