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Sympathetic denervation and reinnervation after arterial switch operation for complete transposition
1Department of Pediatric Cardiology, the Heart Institute of Japan, Tokyo Women's Medical College. pkondou@hij.twmc.ac.jp
Circulation
|June 26, 1998
Summary
Arterial switch operation (ASO) can interrupt cardiac sympathetic nerves. Studies show these nerves denervate early but reinnervate later, with neonatal ASO potentially improving exercise tolerance.
Area of Science:
- Cardiology
- Pediatric Surgery
- Nuclear Medicine
Background:
- Sympathetic cardiopulmonary nerves innervate heart ventricles.
- These nerves may be interrupted during arterial switch operation (ASO) for complete transposition of the great arteries.
Purpose of the Study:
- To investigate and characterize sympathetic denervation and reinnervation after ASO.
- To assess the impact of ASO timing on sympathetic nerve recovery and exercise capacity.
Main Methods:
- Utilized [123I]metaiodobenzylguanidine (MIBG) imaging in 51 post-ASO patients.
- Quantified MIBG uptake using heart-to-mediastinum (H/M) ratio.
- Correlated MIBG uptake with age at surgery and exercise test parameters.
Main Results:
- Early post-ASO (<1 month) showed absent MIBG uptake; late post-ASO (>15 months) showed varied reinnervation.
- Patients operated on at <=55 days of age had higher MIBG uptake rates.
- Positive MIBG uptake correlated with greater heart rate and rate-pressure product during exercise.
Conclusions:
- Cardiac sympathetic nerves undergo early denervation and late reinnervation following ASO.
- Neonatal ASO appears favorable for sympathetic reinnervation, potentially enhancing late exercise tolerance.