Among 137 adults with systemic right ventricle (sRV) physiology followed over 25 years at a tertiary congenital heart disease center, those with d-TGA following atrial switch repair showed markedly lower peak VO2 (60% vs 74% predicted), reduced sRV systolic function (41% vs 47%), and nearly double the rate of anxiety or depression (46% vs 25%) compared to ccTGA patients. Across both subtypes, anxiety and depression correlated with lower exercise capacity, worse NYHA functional class, and lower Kansas City Cardiomyopathy Questionnaire scores.
This retrospective cohort adds quantitative granularity to what clinicians have long suspected: in adults with complex congenital heart anatomy, physical and psychological health are tightly entangled, not parallel concerns. The atrial switch procedures (Mustard/Senning), now largely replaced by the arterial switch operation, left a surviving generation carrying an anatomically mismatched ventricle supporting systemic circulation — a lifelong physiologic tax that apparently extends into mental health burden. The bidirectional relationship between reduced exercise capacity and anxiety/depression is well-documented in acquired heart failure, but data in congenital populations remain sparse.
Limitations are significant: retrospective design, single-center recruitment, and mental health diagnoses extracted from clinical documentation introduce ascertainment bias. Causality cannot be established. As a preprint posted on medRxiv and not yet peer-reviewed, findings require independent validation before influencing clinical protocols. Still, the call for integrated cardiopulmonary and psychiatric assessment in sRV clinics is a pragmatically sound, if incremental, recommendation.
