Reddy Arun, Bisoi Akshay K, Singla Suhas, Patel Chetan D, Das Sambhunath
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
Indian J Nucl Med. 2013 Oct;28(4):210-5. doi: 10.4103/0972-3919.121965.
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.
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.
Prospective study.
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.
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.
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.
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.
动脉调转术（ASO）已成为矫正大动脉转位（TGA）的既定治疗方法。尽管能立即纠正异常血流动力学，但与冠状动脉相关的急性和延迟并发症可能导致发病和死亡。
我们通过使用锝-99m 甲氧基异丁基异腈（MIBI）的静息-负荷心肌灌注单光子发射计算机断层扫描（SPECT）[心肌灌注闪烁显像（MPS）]评估了无症状的动脉调转术后儿童灌注异常的发生率及腺苷的安全性。
前瞻性研究。
我们进行了一项前瞻性单机构研究，对 10 名年龄在 1.25 至 6 岁之间的儿童进行了静息-负荷 MPS 检查。其中 2 例患者合并室间隔缺损，1 例患者有左心室流出道梗阻，另 1 例有陶西格-宾畸形。所有患者在 176±212 天（范围 9 - 560 天）时接受了一期矫正手术。以 140μg/kg/min 的速率静脉持续输注腺苷 6 分钟。
所有连续变量总结为均值±标准差，或范围和中位数。使用非配对数据的曼-惠特尼检验和配对样本的威尔科克森秩检验。
腺苷负荷后心率较基础心率平均增加 59.7±17.0%。在任何情况下均未观察到急性或远期并发症。所有患者在静息或腺苷负荷后均未显示心肌灌注缺损。
对于大动脉转位行动脉调转术的患者，腺苷诱导血管扩张后的 MPS 是安全可行的。一期修复、将切除的冠状动脉纽扣植入新主动脉窦内以及对近端冠状动脉极少或不进行游离可能消除矫正型 TGA 患者灌注缺损的发生。
