Pediatric Cardiology

, Volume 39, Issue 8, pp 1523–1529 | Cite as

Feasibility of Transthoracic Echocardiography Evaluation of Pulmonary Arteries Following Arterial Switch Operation

  • Sean M. Lang
  • R. Lee Crawford
  • Pushpa Shivaram
  • Joshua A. Daily
  • Elijah H. Bolin
  • Xinyu Tang
  • R. Thomas CollinsII
Original Article


Pulmonary artery (PA) stenosis is the most common late sequela following arterial switch for d-transposition of the great arteries. The purpose of this study was to assess the effectiveness of transthoracic echocardiography in evaluating the pulmonary arteries following repair. This was a retrospective, cross-sectional analysis of all echocardiograms performed on patients following arterial switch operation. A numerical scoring system was devised and used to quantify PA visualization based on 2D images, color mapping, and spectral Doppler. The study cohort included 150 patients. The ability to visualize at least one PA was poorer in patients who were older [> 10 years (47%) vs ≤ 10 years (89%) (p < 0.001)], and who had larger body surface area (BSA) (> 1.25 m2 (40%) vs ≤ 1.25 m2 (90%) (p < 0.001)]. Regardless of age, 2D visualization of the pulmonary arteries was poor for the entire cohort. Of those with at least one non-visualized PA, only 54% had alternative imaging performed or ordered within the 5 years at or prior to their last echocardiogram. In conclusion, PA visualization following arterial switch is worse in patients who are older and in those with larger BSA. In such patients, alternative forms of imaging are more likely to be necessary.


LeCompte Transposition Pediatric Congenital heart disease 



Arterial switch operation


Body surface area


Cardiac magnetic resonance imaging


Computed tomography


d-Transposition of the great arteries


Pulmonary artery


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors. Our institution IRB approved the study; it consisted of a retrospective review of de-identified patient information; no procedures were performed on human or animal subjects; and informed consent was not obtained.

Supplementary material

246_2018_1924_MOESM1_ESM.tif (207 kb)
Supplemental Fig. 1—ROC for predicting PA visualization score > 8, using years as a linear effect (TIF 206 KB)
246_2018_1924_MOESM2_ESM.tif (183 kb)
Supplemental Fig. 2—ROC for predicting PA visualization score ≥ 8 using BSA as a linear effect (TIF 182 KB)


  1. 1.
    Shepard CW, Germanakis I, White MT, Powell AJ, Co-Vu J, Geva T (2016) Cardiovascular magnetic resonance findings late after the arterial switch operation. Circ Cardiovasc Imaging 9(9):e004618CrossRefGoogle Scholar
  2. 2.
    Geiger J, Hirtler D, Burk J, Stiller B, Arnold R, Jung B, Langer M, Markl M (2014) Postoperative pulmonary and aortic 3D haemodynamics in patients after repair of transposition of the great arteries. Eur Radiol 24(1):200–208CrossRefGoogle Scholar
  3. 3.
    de Roos A (2016) Role of cardiovascular magnetic resonance imaging in postoperative follow-up after the arterial switch operation for transposition of the great arteries. Circ Cardiovasc Imaging 9(9):e005463PubMedGoogle Scholar
  4. 4.
    Cohen MS, Eidem BW, Cetta F, Fogel MA, Frommelt PC, Ganame J, Han BK, Kimball TR, Johnson RK, Mertens L, Paridon SM, Powell AJ, Lopez L (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):571–621CrossRefGoogle Scholar
  5. 5.
    Cohen MD, Johnson T, Ramrakhiani S (2010) MRI of surgical repair of transposition of the great vessels. AJR Am J Roentgenol 194(1):250–260CrossRefGoogle Scholar
  6. 6.
    Sarris GE, Balmer C, Bonou P, Comas JV, da Cruz E, Chiara LD, Di Donato RM, Fragata J, Jokinen TE, Kirvassilis G, Lytrivi I, Milojevic M, Sharland G, Siepe M, Stein J, Buchel EV, Vouhe PR (2017) Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum. Eur J Cardiothorac Surg 51(1):e1–e32CrossRefGoogle Scholar
  7. 7.
    Rathod RH, Jurgen B, Hamershock RA, Friedman KG, Marshall AC, Samnaliev M, Graham DA, Jenkins K, Lock JE, Powell AJ (2017) Impact of standardized clinical assessment and management plans on resource utilization and costs in children after the arterial switch operation. Congenit Heart Dis 12(6):768–776CrossRefGoogle Scholar
  8. 8.
    Lopez L, Colan SD, Frommelt PC, Ensing GJ, Kendall K, Younoszai AK, Lai WW, Geva T (2010) Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the pediatric measurements writing group of the american society of echocardiography pediatric and congenital heart disease council. J Am Soc Echocardiogr 23(5):465–495CrossRefGoogle Scholar
  9. 9.
    Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ, Waggoner A, Weissman NJ (2003) Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and doppler echocardiography. J Am Soc Echocardiogr 16(7):777–802CrossRefGoogle Scholar
  10. 10.
    Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, Iung B, Otto CM, Pellikka PA, Quinones M (2009) Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr 22(1):1–23CrossRefGoogle Scholar
  11. 11.
    Koo TK, Li MY (2016) A Guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15(2):155–163CrossRefGoogle Scholar
  12. 12.
    Kannan BR, Qureshi SA (2008) Catheterisation laboratory is the place for rehabilitating the pulmonary arteries. Ann Pediatr Cardiol 1(2):107–113CrossRefGoogle Scholar
  13. 13.
    Agnoletti G, Boudjemline Y, Bonnet D, Sidi D, Vouhe P (2004) Surgical reconstruction of occluded pulmonary arteries in patients with congenital heart disease: effects on pulmonary artery growth. Circulation 109(19):2314–2318CrossRefGoogle Scholar
  14. 14.
    Eldridge F, Selzer A, Hultgren H (1957) Stenosis of a branch of the pulmonary artery; an additional cause of continuous murmurs over the chest. Circulation 15(6):865–874CrossRefGoogle Scholar
  15. 15.
    Stern KW, McElhinney DB, Gauvreau K, Geva T, Brown DW (2011) Echocardiographic evaluation before bidirectional Glenn operation in functional single-ventricle heart disease: comparison to catheter angiography. Circ Cardiovasc Imaging 4(5):498–505CrossRefGoogle Scholar
  16. 16.
    Kilner PJ, Geva T, Kaemmerer H, Trindade PT, Schwitter J, Webb GD (2010) Recommendations for cardiovascular magnetic resonance in adults with congenital heart disease from the respective working groups of the European Society of Cardiology. Eur Heart J 31(7):794–805CrossRefGoogle Scholar
  17. 17.
    Friedman KG, Rathod RH, Farias M, Graham D, Powell AJ, Fulton DR, Newburger JW, Colan SD, Jenkins KJ, Lock JE (2010) Resource utilization after introduction of a standardized clinical assessment and management plan. Congenit Heart Dis 5(4):374–381CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Sean M. Lang
    • 1
  • R. Lee Crawford
    • 2
    • 4
  • Pushpa Shivaram
    • 2
    • 3
    • 4
  • Joshua A. Daily
    • 2
    • 3
    • 4
  • Elijah H. Bolin
    • 2
    • 3
    • 4
  • Xinyu Tang
    • 3
    • 4
  • R. Thomas CollinsII
    • 5
  1. 1.The Heart InstituteCincinnati Children’s Medical CenterCincinnatiUSA
  2. 2.Arkansas Children’s HospitalLittle RockUSA
  3. 3.Arkansas Children’s Research InstituteLittle RockUSA
  4. 4.University of Arkansas for Medical SciencesLittle RockUSA
  5. 5.Lucille Packard Children’s HospitalStanford UniversityPalo AltoUSA

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