Post-operative Assessment of the Arterial Switch Operation: A Comparison of Magnetic Resonance Imaging and Echocardiography
After an arterial switch operation (ASO), serial imaging is necessary to monitor for maladaptive changes. We compared cardiac magnetic resonance imaging (CMR) to 2-D transthoracic echocardiography (TTE) in assessing post-operative ASO patients. We performed a retrospective review of patients at a single tertiary care center who underwent an ASO and subsequently had a CMR performed from 7/2010 to 7/2016. Those with single ventricle anatomy, congenitally corrected transposition of the great arteries, or previous atrial switch operation were excluded. TTE obtained within 6 months of the CMR was used for comparison. Parameters compared included ventricular size and systolic function, semilunar valve regurgitation, neo-aortic root dimension, and the presence of branch pulmonary artery (PA) stenosis (on CMR by the Nakata index or right/left flow differential; on TTE by peak velocity > 2 m/s or PA diameter Z score < − 2). Forty-seven patients with 90 CMR and 86 TTE studies met inclusion criteria. CMR and TTE assessment of right ventricular (RV) and left ventricular function did not statistically differ. RV dilation was overdetected by TTE (p = 0.046). Right pulmonary artery and left pulmonary artery (LPA) visualization by TTE was worse than CMR (p < 0.01). There was no statistically significant difference between CMR and TTE assessment of branch PA stenosis; however, there was poor agreement between the use of Z score and velocity when determining branch PA stenosis by TTE (κ < 0). Assessment of neo-pulmonary regurgitation (PR) and neo-aortic regurgitation (AR) was significantly different between CMR and TTE (p < 0.05). Assessment for delayed enhancement was performed in 18% of CMR studies (n = 16), with perfusion defects appreciated in three patients. Substantial differences between CMR and TTE exist when examining the post-operative ASO patient. CMR was superior for evaluation of the branch PAs, which commonly require re-intervention. TTE failed to recognize altered ventricular function in several cases. Differences between TTE and CMR could alter management is some cases. Incorporation of CMR into the routine surveillance of patients who received an ASO is warranted.
KeywordsEchocardiogram Magnetic resonance imaging Arterial switch operation Pulmonary stenosis Transposition of the great arteries
Compliance with Ethical Standards
Conflict of interest
Christopher R. Broda, Svetlana B. Shugh, Rohan B. Parikh, YunFei Wang, Tobias R. Schlingmann, and Cory V. Noel declare that they have no conflicts of interest.
This retrospective chart review study was approved by the IRB at Baylor College of Medicine. Due to the nature of the study, inclusion of patient data was exempt from a requirement of obtaining informed consent.
Research Involving Animal Rights
This article does not contain any studies with animals performed by any of the authors.
- 3.Lang RM, Badano LP, Mor-Avi V et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the american society of echocardiography and the european association of cardiovascular imaging. J Am Soc Echocardiogr 28(1):1–39. https://doi.org/10.1016/j.echo.2014.10.003 CrossRefPubMedGoogle Scholar
- 8.Krupickova S, Muthurangu V, Hughes M et al (2017) Echocardiographic arterial measurements in complex congenital diseases before bidirectional Glenn: comparison with cardiovascular magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 18(3):332–341. https://doi.org/10.1093/ehjci/jew069 PubMedGoogle Scholar
- 12.Cohen MS, Eidem BW, Cetta F et al (2016) Multimodality imaging guidelines of patients with transposition of the great arteries: a report from the american society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance and the society of cardiovascular computed tomography. J Am Soc Echocardiogr 29(7):571–621. https://doi.org/10.1016/j.echo.2016.04.002 CrossRefPubMedGoogle Scholar