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Myocardial perfusion, function and exercise tolerance after the arterial switch operation

S N Weindling1, G Wernovsky, S D Colan

  • 1Department of Cardiology, Children's Hospital, Division of Nuclear Medicine, Boston, Massachusetts 02115.

Journal of the American College of Cardiology
|February 1, 1994
PubMed
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Myocardial perfusion abnormalities are common in children after arterial switch operation, but exercise capacity remains normal. Technetium-99m sestamibi scans show these defects, which generally lessen with exercise, suggesting adequate perfusion during stress.

Area of Science:

  • Pediatric Cardiology
  • Cardiac Surgery
  • Diagnostic Imaging

Background:

  • Sporadic reports of myocardial ischemia and sudden death exist in children post-arterial switch operation for transposition of the great arteries.
  • Potential causes include inadequate coronary perfusion due to kinking or stenosis of translocated coronary arteries.

Purpose of the Study:

  • To determine the prevalence of myocardial perfusion abnormalities at rest and during exercise in children following the arterial switch operation.
  • To assess the exercise capacity in this pediatric population.

Main Methods:

  • Myocardial perfusion was assessed using technetium-99m methoxyisobutyl isonitrile (sestamibi) scintigraphy at rest and peak exercise.
  • Exercise capacity was evaluated using a modified Bruce protocol.

Related Experiment Videos

  • Ambulatory ECG Holter monitoring and echocardiography were performed to assess ventricular function and wall motion.

    • Main Results:

    • Abnormalities were detected on rest perfusion scans in 95.6% of 23 children (aged 4.2–7.9 years).
    • At peak exercise, perfusion defects were present but generally improved compared to rest.
    • All patients exhibited normal exercise tolerance, with no symptoms or ischemic ECG changes, and normal ventricular function.

    Conclusions:

    • Myocardial perfusion scan abnormalities are frequent after arterial switch operation but are of uncertain clinical significance.
    • These perfusion abnormalities tend to lessen during exercise.
    • Normal exercise tolerance suggests adequate myocardial perfusion during physiologic stress in children up to 8 years post-operation.