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Are biventricular and biatrial function truly preserved after arterial switch operation?
  1. Ellen Ostenfeld1,
  2. Marcus Carlsson1,2
  1. 1 Department of Clinical Sciences Lund, Clinical Physiology, Lund University and Skåne University Hospital, Lund, Sweden
  2. 2 Laboratory of Clinical Physiology, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
  1. Correspondence to Dr Ellen Ostenfeld, Department of Clinical Sciences Lund, Clinical Physiology, Lund University and Skåne University Hospital, Lund SE-221 85, Sweden; ellen.ostenfeld{at}

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Arterial switch operation is currently the standard procedure when correcting for transposition of the great arteries (TGA) with a good longevity of the intervention.1 While aortic and coronary artery complications as well as mortality are low, right-sided lesions such as right ventricular (RV) outflow and neopulmonary valve dysfunction may occur and require reintervention.2 Patients undergoing cardiac reinterventions in childhood are more likely to have residual lesions and have a higher risk of valvular and ventricular dysfunction as well as arrhythmia.3

In TGA, left ventricular (LV) function is reported normal at long-term follow-up,4 5 but RV dysfunction is present at mid-term after arterial switch operation.6 Systemic ventricular function has been suggested as a prognostic marker of outcome in TGA after atrial switch and in congenital corrected TGA.7 Even if echocardiography is the first-line imaging modality for cardiovascular evaluation of patients with congenital heart disease, cardiac magnetic resonance (CMR) is considered gold standard for ventricular and atrial volumes and function owing to high accuracy, precision and reproducibility.8 As most studies of patients with TGA and arterial switch operation are small cohorts presenting either on a ventricular or atrial functional results, whole heart assessment including all four cardiac chambers in a comprehensive manner has been lacking. A larger population of patients with TGA and arterial switch operation also allows a meaningful investigation of whether any ventricular and atrial functional alterations could be caused by differences in simple and complex TGA morphology or by usual and …

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  • Contributors Both authors have contributed equally to writing the manuscript and have read and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; externally peer reviewed.

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