Pediatric Cardiology

, Volume 39, Issue 5, pp 1036–1041 | Cite as

Post-operative Assessment of the Arterial Switch Operation: A Comparison of Magnetic Resonance Imaging and Echocardiography

  • Christopher R. Broda
  • Svetlana B. Shugh
  • Rohan B. Parikh
  • YunFei Wang
  • Tobias R. Schlingmann
  • Cory V. Noel
Original Article


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.


Echocardiogram 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.

Ethical Approval

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.


  1. 1.
    Khairy P, Clair M, Fernandes SM et al (2013) Cardiovascular outcomes after the arterial switch operation for D-transposition of the great arteries. Circulation 127(3):331–339. CrossRefPubMedGoogle Scholar
  2. 2.
    Robbers-Visser D, Boersma E, Helbing WA (2009) Normal biventricular function, volumes, and mass in children aged 8 to 17 years. J Magn Reson Imaging 29(3):552–559. CrossRefPubMedGoogle Scholar
  3. 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. CrossRefPubMedGoogle Scholar
  4. 4.
    Nakata S, Imai Y, Takanashi Y et al (1984) A new method for the quantitative standardization of cross-sectional areas of the pulmonary arteries in congenital heart diseases with decreased pulmonary blood flow. J Thorac Cardiovasc Surg 88(4):610–619PubMedGoogle Scholar
  5. 5.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174CrossRefPubMedGoogle Scholar
  6. 6.
    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. PubMedGoogle Scholar
  7. 7.
    Pignatelli RH, McMahon CJ, Chung T, Vick GW 3rd (2003) Role of echocardiography versus MRI for the diagnosis of congenital heart disease. Curr Opin Cardiol 18(5):357–365CrossRefPubMedGoogle Scholar
  8. 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. PubMedGoogle Scholar
  9. 9.
    Losay J, Touchot A, Serraf A et al (2001) Late outcome after arterial switch operation for transposition of the great arteries. Circulation 104(12 Suppl 1):I121-6PubMedGoogle Scholar
  10. 10.
    Kilner PJ (2011) Imaging congenital heart disease in adults. Br J Radiol 84(3):S258–258. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Safi LM, Bhatt AB (2017) Update on the management of adults with arterial switch procedure for transposition of the great arteries. Curr Treat Options Cardiovasc Med 19(1):4. CrossRefPubMedGoogle Scholar
  12. 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. CrossRefPubMedGoogle Scholar

Copyright information

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

Authors and Affiliations

  • Christopher R. Broda
    • 1
  • Svetlana B. Shugh
    • 1
  • Rohan B. Parikh
    • 2
  • YunFei Wang
    • 1
  • Tobias R. Schlingmann
    • 1
  • Cory V. Noel
    • 1
  1. 1.Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric and Congenital CardiologyBaylor College of Medicine/Texas Children’s HospitalHoustonUSA
  2. 2.Department of Internal MedicineWestern Reserve Health EducationYoungstownUSA

Personalised recommendations