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Myocardial Stress Perfusion MRI: Experience in Pediatric and Young-Adult Patients Following Arterial Switch Operation Utilizing Regadenoson

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Abstract

Dextro-transposition of the great arteries (D-TGA) is one of the most common cyanotic heart lesions. The arterial switch operation (ASO) is the preferred surgical palliation for D-TGA. One of the primary concerns following the ASO is complications arising from the coronary artery transfer. There is a need for myocardial perfusion assessment within ASO patients. There is no report on the utility of regadenoson as a stress agent in children following ASO. Our objective was to observe the safety and feasibility of regadenoson as a pharmacologic stressor for perfusion cardiac MR in a pilot cohort of pediatric and young-adult patients who have undergone ASO. We reviewed our initial experience with regadenoson stress cardiac MR in 36 pediatric and young-adult patients 15.1 ± 4.5 years (range 0.2–22 years) with history of ASO. The weight was 61.6 ± 21.5 kg (range 3.8–93 kg). All patients underwent cardiac MR because of concern for ischemia. Subjects’ heart rate and blood pressure were monitored and pharmacologic stress was induced by injection of regadenoson. We evaluated their hemodynamic response and adverse effects using changes in vital signs and onset of symptoms. A pediatric cardiologist and radiologist qualitatively assessed myocardial perfusion and viability images. All stress cardiac MR examinations were completed without adverse events. Resting heart rate was 72 ± 13 beats per minute (bpm) and rose to peak of 120 ± 17 bpm (95 ± 50% increase, p < 0.005) with regadenoson. Image quality was considered good or diagnostic in all cases. A total of 11/36 (31%) patients had a perfusion defect on the stress FPP images. 14 of the 36 patients (39%) underwent cardiac catheterization within 6 months of the CMR and the findings showed excellent agreement. Regadenoson may be a useful coronary hyperemia agent to utilize for pediatric patients following arterial switch procedure when there is concern for ischemia. The ability to administer as a single bolus with one IV makes it advantageous in pediatrics. In a limited number of cases, regadenoson stress perfusion showed excellent agreement with cardiac catheterization.

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Abbreviations

d-TGA:

Dextro-transposition of the great arteries

ASO:

Arterial switch operation

CMR:

Cardiac magnetic resonance imaging

FPP:

First-pass perfusion

IV:

Intravenous

FFR:

Fractional flow reserve

ECG:

Electrocardiogram

EPI:

Echo planar imaging

SSFP:

Steady-state free precession

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Funding

No funding was utilized for this retrospective review.

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Authors and Affiliations

  1. Texas Children’s Hospital, 6621 Fannin Street, MC 19345-C, Houston, TX, 77030, USA

    Cory V. Noel, Ramkumar Krishnamurthy, Prakash Masand, Brady Moffett & Tobiash Schlingmann

  2. Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH, 43205, USA

    Rajesh Krishnamurthy

  3. St. Luke’s Hospital, 6720 Bertner Ave, Houston, TX, 77030, USA

    Benjamin Y. Cheong

Authors
  1. Cory V. Noel
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  2. Ramkumar Krishnamurthy
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  3. Prakash Masand
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  4. Brady Moffett
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  5. Tobiash Schlingmann
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  6. Benjamin Y. Cheong
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  7. Rajesh Krishnamurthy
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Contributions

CVN was responsible for project concept design, image analysis, and manuscript formation. RK was responsible for project design and manuscript formation and revision. PM was responsible for image analysis, manuscript formation, and revision. BM was responsible for regadenoson analysis, administration, and recommendations. TS was responsible for image analysis, manuscript formation, and revision. RK was responsible for project concept design, project objectives, and manuscript revision.

Corresponding author

Correspondence to Cory V. Noel.

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Noel, C.V., Krishnamurthy, R., Masand, P. et al. Myocardial Stress Perfusion MRI: Experience in Pediatric and Young-Adult Patients Following Arterial Switch Operation Utilizing Regadenoson. Pediatr Cardiol 39, 1249–1257 (2018). https://doi.org/10.1007/s00246-018-1890-z

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  • DOI: https://doi.org/10.1007/s00246-018-1890-z

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