Evaluation of myocardial perfusion using positron emission tomography in infants following a neonatal arterial switch operation

R. W M Yates, P. K. Marsden, Ramsey D Badawi, B. F. Cronin, D. R. Anderson, M. J. Tynan, M. N. Maisey, E. J. Baker

Research output: Contribution to journalArticlepeer-review

37 Scopus citations

Abstract

This study was performed to examine the use of positron emission tomography (PET) as a method of evaluating myocardial perfusion after the arterial switch operation for correction of transposition of the great arteries. Eleven asymptomatic patients (median age 2.3 years, range 1.3-4.3 years) post successful neonatal arterial switch repair for transposition underwent cardiac PET scanning using N13 ammonia before and after dipyridamole infusion. Reconstructed data from static scans were analyzed for regional perfusion defects before and after pharmacological stress. Simultaneous assessment of coronary flow before and after stress was performed using a Patlak graphical analysis of data from dynamic scans. Results obtained from PET scanning were correlated with patterns of coronary artery anatomy, electrocardiogram (ECG) recordings, and echocardiographic evaluation. PET scanning demonstrated normal distribution of myocardial perfusion before and after stress in all but one patient, who was found to have a discrete inferior transmural perfusion defect. The defect was well correlated with perioperative ECG changes and a complicated postoperative course. Myocardial blood flow before dipyridamole (0.690 ml/min/g) was similar to reported adult rest values. There was a small but significant (p ≤ 0.002) increase in myocardial blood flow after dipyridamole stress with a mean coronary flow reserve of 1.19 (±0.103). Echocardiographic evaluation failed to demonstrate significant wall motion abnormalities in any of the patients. Cardiac PET scanning is a reliable noninvasive method for evaluation of myocardial perfusion in small children. In this study, the incidence of myocardial perfusion defects after the arterial switch operation is lower than previously reported. The data obtained concerning coronary flow and coronary flow reserve after the arterial switch need to be interpreted with caution because normal data in children are not available.

Original languageEnglish (US)
Pages (from-to)111-118
Number of pages8
JournalPediatric Cardiology
Volume21
Issue number2
DOIs
StatePublished - Mar 2000
Externally publishedYes

Keywords

  • Arterial switch operation
  • Congenital heart disease
  • Myocardial perfusion
  • Positron emission tomography
  • Transposition of the great arteries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health

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