Ntsinjana, HN; (2015) Advanced Imaging and Engineering Techniques for Assessment of Anatomical and Physiological Consequences of the Arterial Switch Operation. Doctoral thesis , UCL (University College London).

Abstract

One of the most important clinical dilemmas in long-term follow up of patients with transposition of the great arteries (TGA) repaired with Arterial Switch Operation (ASO) is the lack of standardized surveillance imaging protocols, owing to the diverse anatomical or physiological sequelae that follow this operation. The aim of this Thesis was to use advanced imaging and engineering tools to assess the anatomical and physiological consequences of the ASO impacting on the left heart. This research was developed in a quest to use non-invasive, low or no radiation tools in the follow-up of ASO survivors in an attempt to contribute to the development of follow up protocols for the ASO survivors. Prior to exploring the methods and results of the imaging and post-processing analysis, this Thesis evaluated the success of the ASO at Great Ormond Hospital for Children (GOSH) over the past 30 years. Subsequently, this research provided quantification of the morphological residua of the ASO visualized on magnetic resonance imaging (MRI) and quantified by engineering tools. The effects of abnormal geometry on haemodynamic response to exercise were analysed. This was followed by in-vitro experiments using patient specific 3D-anatomy of the abnormal geometry, compared with computational experiments using patient data in order to understand the impact that the abnormal geometry has on blood flow profile. Novel, non-invasive MRI derived methodologies were then applied to assess the presence of significant coronary artery obstructions and sub-clinical left ventricular (LV) dysfunction long-term after the ASO. Finally, this Thesis offers insight into the presence of abnormal haemodynamics related to abnormal geometry following ASO. Subclinical LV dysfunction detected by non-invasive novel methodologies may be of concern, as the long-term effects are not understood. The non-invasive, low radiation imaging protocols used in this this Thesis have a significant role to play in developing future imaging follow-up protocols for the survivors of the ASO.

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