ORIGINAL ARTICLE Left Ventricular Function in Patients with Transposition of the Great Arteries Operated with Atrial Switch Eirik Pettersen Æ Harald Lindberg Æ Hans-Jørgen Smith Æ Bjarne Smevik Æ Thor Edvardsen Æ Otto A. Smiseth Æ Kai Andersen Received: 15 August 2007 / Accepted: 26 October 2007 / Published online: 27 November 2007 Ó Springer Science+Business Media, LLC 2007 Abstract In patients operated with atrial switch for transposition of the great arteries (TGA), the left ven- tricle (LV) supports the pulmonary circulation and is thus pressure unloaded. Evaluation of LV function in this setting is of importance, as LV functional abnormalities have been documented and might contribute to devel- opment of symptoms. The ventricular contraction pattern in 14 Senning-operated TGA patients and 14 healthy controls was studied using tissue Doppler and magnetic resonance imaging. In the subpulmonary LV free wall, longitudinal strain was greater than circumferential strain (-23.6 ± 3.6% vs. -19.1 ± 3.2%, p = 0.002) as in the normal right ventricle (RV) (-30.7 ± 3.3% vs. -15.8 ± 1.3%, p \ 0.001), but opposite to findings in the normal LV (-16.5 ± 1.7% vs. -25.7 ± 3.1%, p \ 0.001). Subpulmonary strain and strain rate values were intermediate between those in the normal LV and RV. Ventricular free-wall torsion was reduced in the subpulmonary LV compared with both the normal LV (5.7 ± 3.2° vs. 16.7 ± 5.6°, p \ 0.001) and RV (5.7 ± 3.2° vs. 11.4 ± 2.6°, p \ 0.05). Furthermore, early diastolic filling of the subpulmonary LV differed from that of the normal LV. The subpulmonary LV displayed predominantly longitudinal shortening, as did its functional counterpart, the normal RV. However, the degree and rate of both longitudinal and circumferential shortening were intermediate between those of the nor- mal LV and RV. This could represent a partial adaptation to the reduced pressure load. Decreased ven- tricular torsion and diastolic abnormalities might indicate subclinical ventricular dysfunction. Keywords Transposition of great vessels Á Left ventricular function Á Echocardiography Á Magnetic resonance imaging Introduction Patients with transposition of the great arteries (TGA) operated with atrial switch represent a particular challenge in the management of adults with congenital heart disease. Systemic right ventricular (RV) dysfunction, atrioventric- ular valve regurgitation, baffle obstruction, and arrhythmias have been the main concerns. However, sub- pulmonary left ventricular (LV) functional abnormalities have also been demonstrated in these patients [11] and might contribute to development of symptoms. We have recently described the contraction pattern of the systemic RV in Senning-operated TGA patients in terms of longitudinal and circumferential shortening and ventricular torsion [10]. The systemic RV displays the E. Pettersen (&) Department of Cardiology, Faculty of Medicine, University of Oslo and Rikshospitalet, Oslo, Norway e-mail: eirik.pettersen@medisin.uio.no H. Lindberg Department of Thoracic and Cardiovascular Surgery, Rikshospitalet, Oslo, Norway H.-J. Smith Á B. Smevik Department of Radiology, Faculty of Medicine, University of Oslo and Rikshospitalet, Oslo, Norway T. Edvardsen Á O. A. Smiseth Department of Cardiology, Faculty of Medicine, University of Oslo and Rikshospitalet, Oslo, Norway K. Andersen Department of Thoracic and Cardiovascular Surgery, Rikshospitalet, Oslo, Norway 123 Pediatr Cardiol (2008) 29:597–603 DOI 10.1007/s00246-007-9156-1