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Functional Outcome of Patients Operated...
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Functional Outcome of Patients Operated for Transposition of the Great Arteries With the Mustard Procedure Eric S. Ebenroth, Roger A. Hurwitz, James Whitcomb Riley Hospital for Children, Indianapolis, IN Background: This study was undertaken to determine the functional outcome of adult and adolescent pts who had undergone Mustard repair for d-transposition of the great arteries (DTGA) 8-26 years before (mean 14 years). Methods: Forty-two asymptomatic pts were enrolled. Forty performed maximal exercise treadmill testing. Right ventricular ejection fraction (RVEF) was estimated using radionuclide angiocardiography in 41. Psychoeducational testing was accomplished in 18. Sixteen pts underwent all three tests. Results: Exercise performance was normal in 24/40 (60%), mildly diminished in 11/40 (28%), and abnormal in 5/40 (12%). RVEF was normal (>0.47) in 30/41 (73%). The group undergoing psychoeducational testing fell into a normal distribution of intelligence. Mild learning disabilities with normal intelligence quotient (IQ) were present in three of the 18 pts (17%). Full scale IQ <80 with abnormal adaptive scores was found in two pts (11%). Eight of the 16 pts (50%) who underwent all three tests were normal in all (three of these pts were those with normal IQ and mild learning disabilities). Additionally, four pts (24%) had normal RVEF measurements, a normal psychoeducational battery, and mildly decreased exercise tolerance. One pt (6%) had normal exercise tolerance and psychoeducational scores with a mildly abnormal RVEF. Thus, 13/16 (81%) of the group with complete ?functional? testing had normal or nearly normal cardiac, exercise and psychoeducational performance. Conclusions: In pts operated for DTGA an average of 14 years prior to evaluation, 24% had decreased systemic ventricular function, 12% had reduced exercise tolerance, and 11% had abnormal psychoeducational scores. Eight-one percent of those pts tested had normal or near normal results for all three modalities. Thus, pts treated with the Mustard procedure continue to demonstrate a relatively normal level of both physical and mental performance and quality of life, commensurate with their asymptomatic state. Published in abstract form in The Journal of the American College of Cardiology 33(2) Supplement A: 539A, 1999 Feb. Presented at the Annual American College of Cardiology Meeting, March 1999, New Orleans. Presented at the Pediatric Academic Societies and the American Academy of Pediatrics Joint Meeting, May 2000, Boston. |
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