title: Adenosine stress myocardial perfusion scintigraphy in pediatric patients after arterial switch operation.
abstract: BACKGROUND
  Arterial switch operation (ASO) has become the established treatment for correction of transposition of great arteries (TGA). Despite the immediate correction of abnormal hemodynamics, acute and delayed complications related to the coronaries may cause morbidity and mortality.
  
  
  OBJECTIVE
  We evaluated the incidence of perfusion abnormalities and safety of adenosine by stress-rest myocardial perfusion single-photon emission computed tomography (SPECT) [myocardial perfusion scintigraphy (MPS)] using Tc-99m Sestamibi (MIBI) in asymptomatic children post-ASO.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  We conducted a prospective, single-institutional study where stress-rest MPS was performed on 10 children of age between 1.25 and 6 years. Two of the patients had additional ventricular septal defect, one patient had left ventricular outflow tract obstruction, and another had Taussig-Bing anomaly. All the patients underwent corrective surgery as a single-stage procedure at the age of 176 ± 212 days (range 9-560 days). Adenosine was administered at a rate of 140 μg/kg/min intravenously as continuous infusion for duration of 6 min.
  
  
  METHODS
  All the continuous variables were summarized as mean ± standard deviation, or range and median. Mann-Whitney test for unpaired data and Wilcoxon Rank test for paired samples were used.
  
  
  RESULTS
  The average increase in heart rate over the basal heart rate after adenosine stress was 59.7 ± 17.0%. No acute or remote complications were observed in any case. None of the patients demonstrated myocardial perfusion defects, either at rest or after adenosine stress.
  
  
  CONCLUSIONS
  MPS post-adenosine induced vasodilatation is safe and feasible in patients of ASO for transposition of great arteries. One-stage repair, implantation of excised coronary buttons within neo-aortic sinus, and minimal or no mobilization of proximal coronaries may eliminate the occurrence of perfusion defects in patients of corrected TGA.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Arun
authors.initials: A
authors.lastname: Reddy
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Akshay K
authors.initials: AK
authors.lastname: Bisoi
authors.affiliation: Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Suhas
authors.initials: S
authors.lastname: Singla
authors.affiliation: Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Chetan D
authors.initials: CD
authors.lastname: Patel
authors.affiliation: Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sambhunath
authors.initials: S
authors.lastname: Das
keywords: Adenosine; arterial switch; myocardial perfusion scintigraphy; pediatric