title: Ventricular sympathetic innervation in patients with transposition of the great arteries after arterial switch operation and Rastelli procedure: impact of arterial dissection and coronary reimplantation.
abstract: BACKGROUND
  Coronary flow reserve (CFR) is reduced in patients with transposition of the great arteries (TGA) after the arterial switch operation (ASO). Dissection of the great arteries and coronary reimplantation may result in sympathetic denervation, with a negative effect on myocardial perfusion.
  
  
  RESULTS
  18 patients with TGA participated in the study; 9 had ASO (20.8±5.8 years). Controls were 9 patients after Rastelli procedure (22.1±6.8 years). Sympathetic innervation was measured by positron emission tomography using(11)C epinephrine (EPI). Left ventricular EPI-retention ranged from 6.1% to 15.9%/min. Patients undergoing more than 1 operation had significantly reduced EPI-retention (P<0.001). EPI-retention and time interval after surgery correlated significantly (r=0.81, P<0.001) and was higher in patients undergoing surgery at an earlier age (P<0.001). No significant difference could be found between patients after ASO or Rastelli repair. Aortic cross-clamp time inversely correlated with EPI-retention (r=-0.72; P<0.001).
  
  
  CONCLUSIONS
  The ASO procedure had a negative effect on sympathetic innervation of the myocardium, but because of reinnervation myocardial perfusion is not essentially altered by this mechanism. Heart surgery and prolonged aortic cross-clamp time have a negative effect on the norepinephrine content of cardiac sympathetic nerve terminals. Parameters such as ventricular performance and cardiopulmonary exercise capacity were unaffected by the degree of EPI-retention.
authors.affiliation: Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum Munich.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kuehn
authors.forename: Manfred
authors.initials: M
authors.lastname: Vogt
authors.forename: Markus
authors.initials: M
authors.lastname: Schwaiger
authors.forename: Peter
authors.initials: P
authors.lastname: Ewert
authors.forename: Michael
authors.initials: M
authors.lastname: Hauser
mesh_terms: D000293:Adolescent; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage; D000328:Adult; D017023:Coronary Angiography; D003326:Coronary Circulation; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D049268:Positron-Emission Tomography; D013564:Sympathetic Nervous System / Q000000981:diagnostic imaging / Q000503:physiopathology; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery
chemical_list: D000316:Adrenergic alpha-Agonists; D004837:Epinephrine