Congenital heart disease
Effect of Beta Blockers (Carvedilol or Metoprolol XL) in Patients With Transposition of Great Arteries and Dysfunction of the Systemic Right Ventricle

https://doi.org/10.1016/j.amjcard.2006.10.025Get rights and content

This study evaluated the effects of β blockers (carvedilol and metoprolol XL) on New York Heart Association functional class and systemic right ventricular (RV) function in patients with complete transposition of the great arteries who had systemic RV dysfunction late after atrial inflow correction. A significant improvement in New York Heart Association functional class was found after 4 months of therapy with β blockers. Functional recovery was significant mostly in those patients with pacemakers who received higher maintenance doses of carvedilol. RV end-diastolic area was significantly greater in untreated patients at the end of the follow-up period, whereas it was unchanged in treated patients. In conclusion, β blockers prevent RV remodeling, with a concomitant improvement in exercise tolerance in patients with complete transposition of the great arteries and systemic RV dysfunction.

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Methods and Results

We carried out a retrospective analysis of the medical records of patients who had systemic RV dysfunction late after atrial inflow correction for d-TGA. Sixty patients were included, 31 of whom received β blockers. Baseline demographics are listed in Table 1. Functional classification before and after therapy with β blockers was assessed using New York Heart Association (NYHA) functional class. All available echocardiograms were reviewed. Systemic RV ejection fractions were evaluated by visual

Discussion

In the present study, we found that β blockers resulted in improvement in NYHA functional class in patients with d-TGA and systemic RV dysfunction. This improvement was found to be more significant in patients with pacemakers who received higher maintenance doses of β blockers. We could not demonstrate any significant effect of β blockers on the RV ejection fraction, RV end-diastolic area, or the degree of tricuspid regurgitation. However, untreated patients showed increased RV end-diastolic

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