Implications of Early Aortic Stiffening in Patients With Transposition of the Great Arteries After Arterial Switch Operation

Abstract

BACKGROUND: The elastic function of the aorta in patients with transposition of the great arteries after arterial switch operation (ASO) is suspected to be important for long-term prognosis. METHODS AND RESULTS: Fifty-one patients and 34 controls were studied at 3.0 Tesla with MRI. Forty-three patients (12.8±6.9 years) underwent 1-stage ASO, 8 patients (23.8±6.9 years) had prior pulmonary artery banding (2-stage ASO). Aortic dimensions, distensibility, pulse wave velocity, aortic arch angle, left ventricular (LV) mass, LV systolic function and left atrial (LA) volumes, and LA passive emptying function as marker of LV diastolic function were assessed. Compared with controls, patients had increased aortic root areas (602.6±240.5 versus 356.8±113.4 mm(2)/m; P<0.01) and reduced distensibility of the thoracic aorta most pronounced at the aortic root (3.2±2.0 versus 9.1±4.7×10(-3) mm Hg(-1); P<0.01). Aortic distensibility correlated negatively with the aortic areas (P<0.01). Pulse wave velocity was higher in adults after ASO (5.0±1.0 versus 3.8±1.3 m/s; P<0.01). In contrast to controls pulse wave velocity and distensibility correlated with age in patients (P=0.04 to <0.01), LV mass was higher in patients (P=0.02). LA volumes correlated negatively with aortic root and ascending aortic distensibility and positively with pulse wave velocity (P<0.05). In patients, LA passive emptying function was lower (27.3±8.9 versus 41.1±6.0; P<0.01) and correlated with aortic root distensibility (P=0.004). CONCLUSIONS: Reduced aortic bioelasticity and aortic root dilatation are present in transposition of the great artery patients post ASO and are likely to contribute to LV diastolic dysfunction. Impaired aortic bioelasticity was strongly associated with age, suggesting the usefulness of follow-up studies for early onset of degenerative cardiovascular disease.