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Feasibility and Utility of Adenosine Stress Echocardiography in Children Following Post-Arterial Switch Operation: A Comparison with Technetium 99m-Sestamibi Myocardial Perfusion SPECT (MPS)

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Abstract

There is a need for a sensitive, safe, and cost-effective tool for coronary assessment among asymptomatic post-operative children who have undergone arterial switch operation (ASO) for transposition of great arteries (TGA). Adenosine stress echocardiography may be useful in assessing major structures as well for coronary functional assessment. Twenty-six children [median age 6.0 years; IQR 4.9–7.1 years, (22 boys)], who had undergone ASO at a median age of 40 days (IQR 30–75 days), were prospectively included. Left ventricular ejection fraction (LVEF) was calculated in both rest and stress studies (140 µg/kg/min of adenosine IV over 4 min), along with assessment of regional myocardial wall motion. Coronary flow reserve (CFR) was also measured in the left anterior descending artery (LAD). Technetium 99m-MIBI [0.2mCi/kg] was injected after 2 min of adenosine infusion. Adenosine infusion had to be stopped in two children, due to transient atrioventricular (AV) block. The LVEF increased from 55.87 ± 7.27 to 61.20 ± 7.70% (p  < 0.001) with adenosine stress. No significant regional wall motion abnormality was seen in rest or stress. Distal LAD could not be visualized in four patients. Basal and peak coronary flow velocities were 41.51 ± 14.12 and 74.18 ± 6.01 cm/s. Mean CFR was 1.91 ± 0.51. Myocardial perfusion scintigraphy (MPS) was normal in all the patients. Four patients were lost to follow-up and remaining children did not develop any adverse events in the follow-up period of 64.5 ± 7.19 months. Adenosine stress echocardiography is feasible as the initial screening test in the assessment of asymptomatic post-operative children with ASO, at minimal to no inconvenience to the patient. The findings concurred with stress MPS.

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Author notes

  1. This study has two first authors. Kunal Kumar and Anshul Sharma have equal contribution in writing of this paper.

Authors and Affiliations

  1. Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India

    Kunal Kumar, Anshul Sharma, Chetan Patel & Rakesh Kumar

  2. Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110 029, India

    S. Ramakrsihnan

  3. Department of Cardiac Anesthesiology, All India Institute of Medical Sciences, New Delhi, India

    Sambhunath Das

  4. Department of Cardio-Thoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India

    Tsering Sangdup & A. K. Bisoi

Authors
  1. Kunal Kumar
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  2. Anshul Sharma
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  3. Chetan Patel
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  4. S. Ramakrsihnan
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  5. Sambhunath Das
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  7. Rakesh Kumar
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  8. A. K. Bisoi
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Correspondence to S. Ramakrsihnan.

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Kumar, K., Sharma, A., Patel, C. et al. Feasibility and Utility of Adenosine Stress Echocardiography in Children Following Post-Arterial Switch Operation: A Comparison with Technetium 99m-Sestamibi Myocardial Perfusion SPECT (MPS). Pediatr Cardiol 42, 891–897 (2021). https://doi.org/10.1007/s00246-021-02557-6

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