Standard echocardiography:
All patients underwent complete transthoracic echocardiographic examination according to the American Society of Echocardiography (ASE) guidelines (15) using an ultrasound system; the General Electric (GE) VIVID 9 ultrasound (Horten, Norway) equipped with a multi-frequency transducer probe (3-8 MHz). The echocardiographic examination was done at rest and children who were unable to completely rest during imaging were given light sedation. Measurements were taken in three cardiac cycles and average values were estimated offline and were used for statistical analyses. Intra- and inter-observer variability was studied based on two consecutive results.
Usual examination for Senning patients was done taking into consideration the systemic tricuspid valve regurgitation, the pulmonary and systemic venous baffles dysfunction (Leak or stenosis), the outflow tracts (the left ventricular outflow tract obstruction (LVOT), and the pulmonary valve dysfunction).
Common echocardiographic variables for RV function; RV end-diastolic volume (RV EDV), RV end-systolic volume (RV ESV), and RV ejection fraction (RV EF) were estimated in the apical four-chamber view, using the automated Simpson’s one-plane method. RV EF was assessed automatically by dividing RV EDV - RV ESV / RV EDV. (16) Right ventricular tricuspid annulus plane systolic excursion (TAPSE) was estimated as the amplitude of excursion of the tricuspid annulus from the base toward the apex in systole using M-mode in the apical four-chamber view with cursor was sited at the lateral aspect of the tricuspid valve.