title: Transoesophageal atrial pacing combined with transthoracic two dimensional echocardiography: experience in patients operated on with arterial switch operation for transposition of the great arteries.
abstract: OBJECTIVE
  To assess the feasibility, safety, and diagnostic accuracy of transoesophageal atrial pacing stress echocardiography (TAPSE) combined with two dimensional transthoracic echocardiography (TTE) for evaluation of coronary perfusion in patients undergoing arterial switch operation for transposition of the great arteries.
  
  
  METHODS
  TAPSE combined with TTE was performed at the end of cardiac catheterisation. An ischaemic response was defined as > 1.5 mm horizontal or downsloping ST segment depression or as a new or worsened wall motion abnormality. The results were compared with results of coronary angiography.
  
  
  METHODS
  Tertiary referral centre for paediatric cardiology and cardiac surgery.
  
  
  METHODS
  25 patients, mean (SD) age 29.5 (19) months, mean (SD) weight 12.5 (3.4) kg.
  
  
  METHODS
  Target heart rate (200 beats/min) was attained in 22 of 25 (88%) patients. Electrocardiographic ischaemic changes occurred in 4 of 25 (16%) and wall motion abnormalities in 3 of 25 (12%). Coronary obstructions were found in 2 of 25 (8%) patients.
  
  
  RESULTS
  The test was feasible in all patients, without clinical complications requiring treatment. Compared with coronary angiography, the test had a sensitivity and a specificity of 100% and 95%, respectively, for the echocardiographic stress, and of 100% and 91%, respectively, for the electrocardiographic stress. The negative predictive value was 100% for both the echocardiographic and the electrocardiographic stress tests. The positive predictive value was 66% for the echocardiographic stress and 50% for the electrocardiographic stress tests.
  
  
  CONCLUSIONS
  In these patients TAPSE combined with TTE was feasible and safe and apparently an accurate diagnostic method for evaluation of coronary perfusion. Patients with a negative test may have a low likelihood of major coronary abnormalities and may not require coronary angiography.
authors.affiliation: Servizio di Cardiologia, Istituto G Gaslini Children's Hospital, Genoa, Italy.
authors.forename: E
authors.initials: E
authors.lastname: De Caro
authors.forename: G P
authors.initials: GP
authors.lastname: Ussia
authors.forename: M
authors.initials: M
authors.lastname: Marasini
authors.forename: G
authors.initials: G
authors.lastname: Pongiglione
mesh_terms: D001017:Aortic Coarctation / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D003326:Coronary Circulation; D004452:Echocardiography / Q000009:adverse effects / Q000379:methods*; D025401:Echocardiography, Stress / Q000009:adverse effects / Q000379:methods; D005240:Feasibility Studies; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007223:Infant; D012680:Sensitivity and Specificity; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000601:surgery