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.
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.
authors.affiliation: Cardiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain, nachi_pizzi@yahoo.com.ar.
authors.forename: María N
authors.initials: MN
authors.lastname: Pizzi
authors.forename: Elisa
authors.initials: E
authors.lastname: Franquet
authors.forename: Santiago
authors.initials: S
authors.lastname: Aguadé-Bruix
authors.forename: Begoña
authors.initials: B
authors.lastname: Manso
authors.forename: Jaume
authors.initials: J
authors.lastname: Casaldáliga
authors.forename: Gemma
authors.initials: G
authors.lastname: Cuberas-Borrós
authors.forename: Guillermo
authors.initials: G
authors.lastname: Romero-Farina
authors.forename: Josep
authors.initials: J
authors.lastname: Pinar
authors.forename: Joan
authors.initials: J
authors.lastname: Castell-Conesa
authors.forename: David
authors.initials: D
authors.lastname: García-Dorado
authors.forename: Jaume
authors.initials: J
authors.lastname: Candell-Riera
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures; D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003326:Coronary Circulation / Q000502:physiology*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D011183:Postoperative Complications; D011184:Postoperative Period; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012146:Rest; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi