Long-Term Follow-up Assessment After the Arterial Switch Operation for Correction of Dextro-Transposition of the Great Arteries by Means of Exercise Myocardial Perfusion-Gated SPECT
The arterial switch operation (ASO) is the preferred technique for correcting transposition of the great arteries, but translocation and reimplantation of the coronary arteries can produce myocardial ischemia. This report aims to describe the authors’ experience with exercise single-photon emission...
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Published in | Pediatric cardiology Vol. 35; no. 2; pp. 197 - 207 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
New York
Springer US
01.02.2014
Springer |
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Abstract | The arterial switch operation (ASO) is the preferred technique for correcting transposition of the great arteries, but translocation and reimplantation of the coronary arteries can produce myocardial ischemia. This report aims to describe the authors’ experience with exercise single-photon emission computed tomography (SPECT) used to evaluate myocardial perfusion. Exercise-rest gated-myocardial perfusion SPECT was performed for 69 patients (49 boys; median age, 9 years; 5th percentile [6.4 years] to 95th percentile [15.6 years]), 64 of whom were asymptomatic 9.98 ± 3.20 years after ASO. During exercise testing, the patients reached 9.85 ± 3.05 metabolic equivalents (METs) and a median heart rate of 160 beats per minute (bpm), 5th percentile (106 bpm) to 95th percentile (196 bpm). Whereas 61 patients (88.41 %) had normal myocardial perfusion, 2 patients (2.9 %) had reversible defects, and 6 patients (8.7 %) had fixed defects. All the patients with perioperative ischemic complications (4/4, 100 %) had myocardial perfusion defects, whereas four patients (4/65, 6.15 %) without ischemic complications had abnormal perfusion (
p
= 0.0005). Age at the time of surgery did not differ significantly (
p
= 0.234) between the patients with perfusion defects and those with normal study results. No significant difference was observed between the patients who had an A coronary pattern (left coronary artery originating from the left sinus and the right coronary artery originating from the right sinus,
n
= 47) and those who had a non-A coronary pattern (
n
= 22) (
p
= 1). The high rate for normality of exercise myocardial perfusion in our study suggests that myocardial perfusion gated-SPECT should be reserved for patients who have experienced perioperative ischemic complications or those with symptoms, at least during the first 10 years after the surgery. |
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AbstractList | The arterial switch operation (ASO) is the preferred technique for correcting transposition of the great arteries, but translocation and reimplantation of the coronary arteries can produce myocardial ischemia. This report aims to describe the authors’ experience with exercise single-photon emission computed tomography (SPECT) used to evaluate myocardial perfusion. Exercise-rest gated-myocardial perfusion SPECT was performed for 69 patients (49 boys; median age, 9 years; 5th percentile [6.4 years] to 95th percentile [15.6 years]), 64 of whom were asymptomatic 9.98 ± 3.20 years after ASO. During exercise testing, the patients reached 9.85 ± 3.05 metabolic equivalents (METs) and a median heart rate of 160 beats per minute (bpm), 5th percentile (106 bpm) to 95th percentile (196 bpm). Whereas 61 patients (88.41 %) had normal myocardial perfusion, 2 patients (2.9 %) had reversible defects, and 6 patients (8.7 %) had fixed defects. All the patients with perioperative ischemic complications (4/4, 100 %) had myocardial perfusion defects, whereas four patients (4/65, 6.15 %) without ischemic complications had abnormal perfusion (
p
= 0.0005). Age at the time of surgery did not differ significantly (
p
= 0.234) between the patients with perfusion defects and those with normal study results. No significant difference was observed between the patients who had an A coronary pattern (left coronary artery originating from the left sinus and the right coronary artery originating from the right sinus,
n
= 47) and those who had a non-A coronary pattern (
n
= 22) (
p
= 1). The high rate for normality of exercise myocardial perfusion in our study suggests that myocardial perfusion gated-SPECT should be reserved for patients who have experienced perioperative ischemic complications or those with symptoms, at least during the first 10 years after the surgery. The arterial switch operation (ASO) is the preferred technique for correcting transposition of the great arteries, but translocation and reimplantation of the coronary arteries can produce myocardial ischemia. This report aims to describe the authors' experience with exercise single-photon emission computed tomography (SPECT) used to evaluate myocardial perfusion. Exercise-rest gated-myocardial perfusion SPECT was performed for 69 patients (49 boys; median age, 9 years; 5th percentile [6.4 years] to 95th percentile [15.6 years]), 64 of whom were asymptomatic 9.98 ± 3.20 years after ASO. During exercise testing, the patients reached 9.85 ± 3.05 metabolic equivalents (METs) and a median heart rate of 160 beats per minute (bpm), 5th percentile (106 bpm) to 95th percentile (196 bpm). Whereas 61 patients (88.41 %) had normal myocardial perfusion, 2 patients (2.9 %) had reversible defects, and 6 patients (8.7 %) had fixed defects. All the patients with perioperative ischemic complications (4/4, 100 %) had myocardial perfusion defects, whereas four patients (4/65, 6.15 %) without ischemic complications had abnormal perfusion (p = 0.0005). Age at the time of surgery did not differ significantly (p = 0.234) between the patients with perfusion defects and those with normal study results. No significant difference was observed between the patients who had an A coronary pattern (left coronary artery originating from the left sinus and the right coronary artery originating from the right sinus, n = 47) and those who had a non-A coronary pattern (n = 22) (p = 1). The high rate for normality of exercise myocardial perfusion in our study suggests that myocardial perfusion gated-SPECT should be reserved for patients who have experienced perioperative ischemic complications or those with symptoms, at least during the first 10 years after the surgery. The arterial switch operation (ASO) is the preferred technique for correcting transposition of the great arteries, but translocation and reimplantation of the coronary arteries can produce myocardial ischemia. This report aims to describe the authors' experience with exercise single-photon emission computed tomography (SPECT) used to evaluate myocardial perfusion. Exercise-rest gated-myocardial perfusion SPECT was performed for 69 patients (49 boys; median age, 9 years; 5th percentile [6.4 years] to 95th percentile [15.6 years]), 64 of whom were asymptomatic 9.98 ± 3.20 years after ASO. During exercise testing, the patients reached 9.85 ± 3.05 metabolic equivalents (METs) and a median heart rate of 160 beats per minute (bpm), 5th percentile (106 bpm) to 95th percentile (196 bpm). Whereas 61 patients (88.41 %) had normal myocardial perfusion, 2 patients (2.9 %) had reversible defects, and 6 patients (8.7 %) had fixed defects. All the patients with perioperative ischemic complications (4/4, 100 %) had myocardial perfusion defects, whereas four patients (4/65, 6.15 %) without ischemic complications had abnormal perfusion (p = 0.0005). Age at the time of surgery did not differ significantly (p = 0.234) between the patients with perfusion defects and those with normal study results. No significant difference was observed between the patients who had an A coronary pattern (left coronary artery originating from the left sinus and the right coronary artery originating from the right sinus, n = 47) and those who had a non-A coronary pattern (n = 22) (p = 1). The high rate for normality of exercise myocardial perfusion in our study suggests that myocardial perfusion gated-SPECT should be reserved for patients who have experienced perioperative ischemic complications or those with symptoms, at least during the first 10 years after the surgery. |
Audience | Academic |
Author | Candell-Riera, Jaume Casaldáliga, Jaume Franquet, Elisa Pizzi, María N. Manso, Begoña García-Dorado, David Romero-Farina, Guillermo Pinar, Josep Castell-Conesa, Joan Aguadé-Bruix, Santiago Cuberas-Borrós, Gemma |
Author_xml | – sequence: 1 givenname: María N. surname: Pizzi fullname: Pizzi, María N. email: nachi_pizzi@yahoo.com.ar organization: Cardiology Department, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona – sequence: 2 givenname: Elisa surname: Franquet fullname: Franquet, Elisa organization: Nuclear Medicine Department, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona – sequence: 3 givenname: Santiago surname: Aguadé-Bruix fullname: Aguadé-Bruix, Santiago organization: Nuclear Medicine Department, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona – sequence: 4 givenname: Begoña surname: Manso fullname: Manso, Begoña organization: Department of Paediatric Cardiology, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona – sequence: 5 givenname: Jaume surname: Casaldáliga fullname: Casaldáliga, Jaume organization: Adult Congenital Heart Disease Unit, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona – sequence: 6 givenname: Gemma surname: Cuberas-Borrós fullname: Cuberas-Borrós, Gemma organization: Cardiology Department, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona – sequence: 7 givenname: Guillermo surname: Romero-Farina fullname: Romero-Farina, Guillermo organization: Cardiology Department, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona – sequence: 8 givenname: Josep surname: Pinar fullname: Pinar, Josep organization: Cardiology Department, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona – sequence: 9 givenname: Joan surname: Castell-Conesa fullname: Castell-Conesa, Joan organization: Nuclear Medicine Department, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona – sequence: 10 givenname: David surname: García-Dorado fullname: García-Dorado, David organization: Cardiology Department, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona – sequence: 11 givenname: Jaume surname: Candell-Riera fullname: Candell-Riera, Jaume organization: Cardiology Department, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/23843104$$D View this record in MEDLINE/PubMed |
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Keywords | Exercise D-Transposition of great arteries Myocardial perfusion Coronary artery disease SPECT |
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SubjectTerms | Adolescent Arteries Cardiac patients Cardiac Surgery Cardiac Surgical Procedures Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography - methods Cardiology Child Child, Preschool Coronary Circulation - physiology CT imaging Exercise Test - methods Female Follow-Up Studies Heart beat Humans Ischemia Male Medicine Medicine & Public Health Myocardial Ischemia - diagnostic imaging Myocardial Ischemia - etiology Myocardial Ischemia - physiopathology Original Article Postoperative Complications Postoperative Period Radiopharmaceuticals Reproducibility of Results Rest Retrospective Studies SPECT imaging Technetium Tc 99m Sestamibi Time Factors Transposition of great arteries Transposition of Great Vessels - diagnostic imaging Transposition of Great Vessels - physiopathology Transposition of Great Vessels - surgery Vascular Surgery Young Adult |
Title | Long-Term Follow-up Assessment After the Arterial Switch Operation for Correction of Dextro-Transposition of the Great Arteries by Means of Exercise Myocardial Perfusion-Gated SPECT |
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