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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References
Acar P, Maunoury C, Bonnet D, Sébahoun S, Bonhoeffer P, Saliba Z et al (2001) Comparison of myocardial perfusion single-photon emission computed tomography with coronary artery angiography after arterial switch operation. Am J Cardiol 87:1425–1427
Bellhouse VJ, Bellhouse FH (1968) Fluid mechanics of the aortic coronary flow. Nature 41:966–978
Bjorkhem G, Evander E, White T, Lundstrom NR (1990) Myocardial scintigraphy with 201thallium in paediatric cardiology: a review of 52 cases. Pediatr Cardiol 11:1–7
Day WR, Laks H, Drinkwater DC (1992) The influence of coronary anatomy on the arterial switch operation in neonates. J Thorac Cardiovasc Surg 104:706–711
Di Caril MF, Tobes MC, Mangner T, Levine AB, Muzik O, Chakroborty P, Levine B (1997) Effects of cardiac sympathetic innervation on coronary blood flow. N Engl J Med 336:1208–1215
Fukushima H, Satous S, Satou I (1992) Thallium-201 myocardial imaging in cases involving transposition of the great arteries after the arterial switch operation. Kokyo-To-Junkan 40:485–490
Germano G, Kavanagh PB, Waechter P, Agreeda J, Van Kriekinge S, Sharir T et al (2000) A new algorithm for the quantitation of myocardial perfusion SPECT: I. Technical principles and reproducibility. J Nucl Med 41:712–719
Gittenberger de Groot AC, Sauer U, Oppenheimer-Dekker A, Quaegebeur J (1983) Coronary arterial anatomy in transposition of the great arteries: a morphological study. Pediatr Cardiol 4(Suppl 1):15–24
Hauser M, Bengel FM, Kühn A, Sauer U, Zylla S, Braun SL et al (2001) Myocardial blood flow and flow reserve after coronary reimplantation in patients after arterial switch and Ross operation. Circulation 103:1875–1880
Hayes AM, Baker EJ, Kakadeker A (1994) Influence of anatomic correction for transposition of the great arteries on myocardial perfusion: radionuclide imaging with Tc99m 2-methoxy isobutyl isonitrile. J Am Cardiol 24:769–777
Hui L, Chau AKT, Leung MP, Chiu CSW, Cheung YF (2005) Assessment of left ventricular function long term after arterial switch operation for transposition of the great arteries by dobutamine stress echocardiography. Heart 91:68–72
Hutter PA, Bennink G, Ay L, Raes IB, Hitchcock JF, Meijboom EJ (2000) Influence of coronary anatomy and reimplantation on the long-term outcome of the arterial switch. Eur J Cardiothorac Surg 18:207–213
Jatene AD, Fontes VF, Paulista PP et al (1976) Anatomic correction of transposition of the great vessels. J Thorac Cardiovasc Surg 72:364–370
Khairy P, Clair M, Fernandes SM, Blume ED, Powell AJ, Newburger JW et al (2013) Cardiovascular outcomes after the arterial switch operation for D-transposition of the great arteries. Circulation 127:331–339
Konstantinov IE, Alexi-Meskishvili VV, Williams WG, Freedom RM, Praagh RV (2004) Atrial switch operation: past, present, and future. Ann Thorac Surg 77:2250–2258
Lalezari S, Bruggemans EF, Blom NA, Hazekamp MG (2011) Thirty-year experience with the arterial switch operation. Ann Thorac Surg 92:973–979
Lecompte Y, Zannini L, Hazan E (1981) Anatomic correction of transposition of the great arteries. J Thorac Cardiovasc Surg 82:629–631
Liebman J, Cullum L, Belloc NB (1969) Natural history of transposition of the great arteries: anatomy and birth and death characteristics. Circulation 40:237–262
Manso B, Castellote A, Dos L, Casaldáliga J (2010) Myocardial perfusion magnetic resonance imaging for detecting coronary function anomalies in asymptomatic paediatric patients with a previous arterial switch operation for the transposition of great arteries. Cardiol Young 20:410–417
Marcora S, Di Renzi P, Giannico S, Pierleoni M, Bellelli A, Sanders SP (2011) A CT study of coronary arteries in adult Mustard patients. JACC Imaging 4:89–93
Mayer JE, Sanders SP, Jonas RPL, Castaneda AR, Wernovsky G (1990) Coronary artery pattern and outcome of arterial switch operation for transposition of the great arteries. Circulation 82(Suppl IV):139–145
Mustard WT (1964) The surgical management of transposition of the great vessels. J Thorac Cardiovasc Surg 48:953–958
Olson EN (1997) Things are developing in cardiology. Circ Res 80:604–606
Pasquali S, Hasselblad V, Li JS, Kong DF, Sanders S (2002) Coronary artery pattern and outcome of arterial switch operation for transposition of great arteries: meta-analysis. Circulation 106:2575–2580
Pedra SRFF, Pedra CAC, Abizaid AA, Braga S, Staico R, Arrieta R et al (2005) Intracoronary ultrasound assessment late after the arterial switch operation for transposition of the great arteries. J Am Coll Cardiol 45:2061–2068
Planche C, Bruniaux J, Lacour-Gayet F (1988) Switch operation for transposition of the great arteries in neonates. J Thorac Cardiovasc Surg 96:354–363
Rickers C, Sasse K, Buchert R, Stern Heiko, Van den Hoff J, Lübeck M, Weil J (2000) Myocardial viability assessed by positron emission tomography in infants and children after the arterial switch operation and suspected infarction. J Am Coll Cardiol 36:1676–1683
Roche SL, Silversides CK, Oechslin EN (2011) Monitoring the patient with transposition of the great arteries: arterial switch versus atrial switch. Curr Cardiol Rep 13:336–346
Rudra HS, Mavroudis C, Backer CL, Kaushal S, Russell H, Stewart RD et al (2011) The arterial switch operation: 25-year experience with 258 patients. Ann Thorac Surg 92:1742–1746
Senning A (1959) Surgical correction of transposition of the great vessels. Surgery 45:966–980
Slomka PJ, Berman D, Xu Y, Kavanagh P, Heyes S, Sharmila Dorbala et al (2012) Fully automated wall motion and thickening scoring system for myocardial perfusion SPECT: method development and validation in large population. J Nucl Cardiol 19:291–302
Sterrett LE, Schamberger MS, Ebenroth ES, Siddiqui AR, Hurwitz RA (2011) Myocardial perfusion and exercise capacity 12 years after arterial switch surgery for D-transposition of the great arteries. Pediatr Cardiol 32:785–791
Tanel RE, Wenovsky G, Landzber J, Perry SB, Burke RP (1995) Coronary artery abnormalities detected at cardiac catheterization following arterial switch operation for transposition of great arteries. Am J Cardiol 76:153–157
Tsuda E, Imakita M, Yagihara T, Ono Y, Echigo S, Takahashi O, Kamiya T (1992) Late death after arterial switch operation for transposition of the great arteries. Am Heart J 124:1551–1557
Turner DR, Muzik O, Forbes TJ et al (2010) Coronary diameter and vasodilator function in children following arterial switch operation for complete transposition of the great arteries. Am J Cardiol 106:421–425
Vogel M, Smallhorn JF, Gilday D, Benson LN, Ash J, Williams WG, Freedom RM (1991) Assessment of myocardial perfusion in patients after the arterial switch operation. J Nucl Med 32:237–241
Weindling SN, Wernovsky G, Colan SD, Parker JA, Boutin C, Mone S et al (1994) Myocardial perfusion, function, and exercise tolerance after the arterial switch operation. J Am Cardiol 23:424–433
Yacoub MH, Radley-Smith R (1978) Anatomy of the coronary arteries in transposition of the great arteries and methods for their transfer in anatomical correction. Thorax 33:418–424
Yates RWM, Marsden PK, Badawi RD, Cronin BF, Anderson DR, Tynana MJ et al (2000) Evaluation of myocardial perfusion using positron emission tomography in infants following a neonatal arterial switch operation. Pediatr Cardiol 21:111–118
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Pizzi, M.N., Franquet, E., Aguadé-Bruix, S. et al. 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. Pediatr Cardiol 35, 197–207 (2014). https://doi.org/10.1007/s00246-013-0759-4
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DOI: https://doi.org/10.1007/s00246-013-0759-4