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Myocardial perfusion scanning in patients considered for late arterial switch

Published online by Cambridge University Press:  19 August 2008

Karen A McLeod ,
Joseph De Giovanni ,
Eric Silove ,
Helen Alton ,
Robert Poyner  and
William Brawn
Karen A McLeod*
Affiliation:
Royal Hospital for Sick Children, Glasgow, UK
Joseph De Giovanni
Affiliation:
Heart Unit, Birmingham Children's Hospital
Eric Silove
Affiliation:
Heart Unit, Birmingham Children's Hospital
Helen Alton
Affiliation:
Department of Nuclear Cardiology, University Hospital NHS Trust, Birmingham;
Robert Poyner
Affiliation:
Department of Nuclear Cardiology, University Hospital NHS Trust, Birmingham;
William Brawn
Affiliation:
Heart Unit, Birmingham Children's Hospital
*
Dr KA McLeod, Royal Hospital for Sick children, Yorkhill NHS Trust, Glasgow, G3 8SJ, UK. Tel: 0141 201 0246; Fax: 0141 201 0853
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Abstract

Background

Our aims were to evaluate left ventricular uptake of radionuclide in patients with Mustard's or Senning's procedure, comparing them with patients who had undergone banding of the pulmonary trunk and conversion to the arterial switch.

Methods

Technetium perfusion scans were performed on 27 patients (25 male), aged from 10 to 28 years with a mean of 17.8 years and a standard deviation of 5.8 years, who had undergone Mustard's or Senning's procedure for correction of complete transposition. Of the 27 patients, six had been accepted for staged conversion to an arterial switch. At the time of the study, two of the six patients had undergone completion to the switch and four had undergone banding of the pulmonary trunk with two then proceeding to the arterial switch. Cardiac catheterisation to measure left ventricular pressure was performed in all six patients and scores for left ventricular uptake of isotope were compared with echocardiographic index of the thickness of the left ventricular posterior wall and measure ments of left ventricular pressure.

Results

Uptake of isotope by the left ventricle was generally poor, but was higher in patients following banding and conversion to the arterial switch, as well as in two patients with native obstruction of the left ventricular outflow tract, and one other who subsequently was found to have pulmonary venous obstruction. There was a positive correlation between the thickness of the left posterior wall in diastole and left ventricular uptake of isotope (r = 0.74, p< 0.05). There also a positive correlation between left ventricular pressure and uptake of the isotope (r = 0.68, p<0.05).

Conclusions

Uptake of radionuclide by the left ventricle after Mustard's or Senning's procedure for complete transposition appears to reflect ventricular pressure and myocardial mass. A prospective study would be required to determine the predictive ability of such scans regarding the ultimate outcome of conversion to arterial switch, but our initial findings suggest that the technique provides an additional non-invasive method of monitoring left ventricular response to pulmonary arterial banding.

Keywords

radionuclidetransposition of the great arteriespulmonary bandingarterial switch
Type
Original Articles
Information
Cardiology in the Young , Volume 10 , Issue 1 , January 2000 , pp. 21 - 26
Copyright
Copyright © Cambridge University Press 2000

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