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Published on: February 16, 2016
Adenosine stress myocardial perfusion scintigraphy in pediatric patients after arterial switch operation
Arun Reddy1, Akshay K Bisoi1, Suhas Singla2
1Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
Insights
Myocardial perfusion scintigraphy (MPS) using adenosine is safe for asymptomatic children after arterial switch operation (ASO) for transposition of the great arteries (TGA). This non-invasive imaging technique revealed no perfusion defects in patients, suggesting successful surgical outcomes.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- Arterial switch operation (ASO) is the standard surgical correction for transposition of the great arteries (TGA).
- Coronary artery complications can occur post-ASO, leading to significant morbidity and mortality.
- Asymptomatic patients require reliable methods to assess for potential cardiac complications.
Purpose of the Study:
- To evaluate the safety and effectiveness of adenosine stress-rest myocardial perfusion single-photon emission computed tomography (MPS) using Tc-99m Sestamibi.
- To determine the incidence of perfusion abnormalities in asymptomatic children following ASO for TGA.
Main Methods:
- A prospective, single-institutional study involving 10 children (age 1.25-6 years) who underwent ASO.
- Stress-rest MPS was performed using Tc-99m Sestamibi with adenosine infusion (140 μg/kg/min for 6 min).
- Statistical analysis included Mann-Whitney and Wilcoxon Rank tests.
Main Results:
- Adenosine administration resulted in an average heart rate increase of 59.7 ± 17.0% without acute or remote complications.
- No myocardial perfusion defects were observed in any patient, either at rest or during adenosine stress.
- The procedure was well-tolerated by all pediatric participants.
Conclusions:
- Adenosine-induced vasodilatation for MPS is a safe and feasible diagnostic tool in children post-ASO for TGA.
- The findings suggest that one-stage repair techniques and specific surgical approaches may prevent perfusion defects.
- MPS can be a valuable tool for monitoring asymptomatic TGA patients after ASO.
Context:
Arterial switch operation (ASO) has become the established treatment for correction of transposition of great arteries (TGA). Despite the immediate correction of abnormal hemodynamics, acute and delayed complications related to the coronaries may cause morbidity and mortality.
Aims:
We evaluated the incidence of perfusion abnormalities and safety of adenosine by stress-rest myocardial perfusion single-photon emission computed tomography (SPECT) [myocardial perfusion scintigraphy (MPS)] using Tc-99m Sestamibi (MIBI) in asymptomatic children post-ASO.
Settings And Design:
Prospective study.
Materials And Methods:
We conducted a prospective, single-institutional study where stress-rest MPS was performed on 10 children of age between 1.25 and 6 years. Two of the patients had additional ventricular septal defect, one patient had left ventricular outflow tract obstruction, and another had Taussig-Bing anomaly. All the patients underwent corrective surgery as a single-stage procedure at the age of 176 ± 212 days (range 9-560 days). Adenosine was administered at a rate of 140 μg/kg/min intravenously as continuous infusion for duration of 6 min.
Statistical Analysis Used:
All the continuous variables were summarized as mean ± standard deviation, or range and median. Mann-Whitney test for unpaired data and Wilcoxon Rank test for paired samples were used.
Results:
The average increase in heart rate over the basal heart rate after adenosine stress was 59.7 ± 17.0%. No acute or remote complications were observed in any case. None of the patients demonstrated myocardial perfusion defects, either at rest or after adenosine stress.
Conclusions:
MPS post-adenosine induced vasodilatation is safe and feasible in patients of ASO for transposition of great arteries. One-stage repair, implantation of excised coronary buttons within neo-aortic sinus, and minimal or no mobilization of proximal coronaries may eliminate the occurrence of perfusion defects in patients of corrected TGA.
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