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CLINICAL STUDY

Myocardial viability assessed by positron emission tomography in infants and children after the arterial switch operation and suspected infarction

Carsten Rickers, MD^*, Karin Sasse, MD^*, Ralph Buchert, PhD, Heiko Stern, MD^*, J.örg van den Hoff, PhD, Martin Lübeck, MD and Jochen Weil, MD^*

^* Department of Pediatric Cardiology, University Hospital Eppendorf, Martinistarasse 52, 20246 Hamburg, Germany
Department of Nuclear Medicine, University Hospital Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
Department of Nuclear Medicine, Medical School Hanover, Konstantin-Gutschow-Strasse 8, 30625 Hanover, Germany

Manuscript received January 26, 2000; revised manuscript received April 24, 2000, accepted June 21, 2000.

Reprint requests and correspondence to: Dr. Carsten Rickers, University Hospital Eppendorf, Department of Pediatric Cardiology, Martinistrasse 52, 20246 Hamburg, Germany.
kinderkardiologie{at}uke.uni-hamburg.de

OBJECTIVES

The aim of the study was to assess regional glucose metabolism and contractile function by gated positron emission tomography using fluoro-18-deoxyglucose (FDG-PET) in pediatric patients after the arterial switch operation and suspected myocardial infarction.

BACKGROUND

Morbidity and mortality after the arterial switch operation for transposition of the great arteries are often related to impaired coronary function. Justification of high-risk revascularization procedure in infancy requires thorough evaluation of myocardial viability. Although PET is state-of-the-art for evaluation of myocardial viability in adults there are no reports on its impact and feasibility in infants and children.

METHODS

We applied electrocardiogram-triggered FDG-PET for assessment of metabolic and functional status of the myocardium in seven infants and seven children. Glucose metabolism, wall motion and wall thickening were evaluated visually and quantitatively on the basis of parametric 3-D images. Additionally, single-photon emission computed tomography perfusion scan was performed in six children.

RESULTS

In two of seven infants, FDG-PET demonstrated viable myocardium in akinetic or hypokinetic regions corresponding to a coronary artery stenosis or occlusion. Therefore, indication for revascularization was derived from this finding. In six of the seven children, impaired glucose uptake reflecting myocardial scarring was present. Two patients had pathological findings on coronary angiography and signs of ischemia but were not suitable for revascularization.

CONCLUSIONS

Myocardial viability and contractile function can be assessed simultaneously by gated FDG-PET even in infant hearts. This method contributes pertinent information to guide further therapy after the arterial switch operation and suspected myocardial infarction.

Abbreviations and Acronyms   ECG = electrocardiogram, electrocardiographic   FDG-PET = fluoro-18-deoxyglucose positron emission tomography   IV = intravenous   LAD = left anterior descending artery   LCA = left coronary artery   LV = left ventricular, left ventricle   MI = myocardial infarction   PTCA = percutaneous transluminal coronary angioplasty   SPECT = single-photon emission computed tomography   TGA = transposition of the great arteries

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