Document Detail


Transoesophageal atrial pacing combined with transthoracic two dimensional echocardiography: experience in patients operated on with arterial switch operation for transposition of the great arteries.
MedLine Citation:
PMID:  12482802     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To assess the feasibility, safety, and diagnostic accuracy of transoesophageal atrial pacing stress echocardiography (TAPSE) combined with two dimensional transthoracic echocardiography (TTE) for evaluation of coronary perfusion in patients undergoing arterial switch operation for transposition of the great arteries.
DESIGN: TAPSE combined with TTE was performed at the end of cardiac catheterisation. An ischaemic response was defined as > 1.5 mm horizontal or downsloping ST segment depression or as a new or worsened wall motion abnormality. The results were compared with results of coronary angiography.
SETTING: Tertiary referral centre for paediatric cardiology and cardiac surgery.
PATIENTS: 25 patients, mean (SD) age 29.5 (19) months, mean (SD) weight 12.5 (3.4) kg.
MAIN OUTCOME MEASURES: Target heart rate (200 beats/min) was attained in 22 of 25 (88%) patients. Electrocardiographic ischaemic changes occurred in 4 of 25 (16%) and wall motion abnormalities in 3 of 25 (12%). Coronary obstructions were found in 2 of 25 (8%) patients.
RESULTS: The test was feasible in all patients, without clinical complications requiring treatment. Compared with coronary angiography, the test had a sensitivity and a specificity of 100% and 95%, respectively, for the echocardiographic stress, and of 100% and 91%, respectively, for the electrocardiographic stress. The negative predictive value was 100% for both the echocardiographic and the electrocardiographic stress tests. The positive predictive value was 66% for the echocardiographic stress and 50% for the electrocardiographic stress tests.
CONCLUSIONS: In these patients TAPSE combined with TTE was feasible and safe and apparently an accurate diagnostic method for evaluation of coronary perfusion. Patients with a negative test may have a low likelihood of major coronary abnormalities and may not require coronary angiography.
Authors:
E De Caro; G P Ussia; M Marasini; G Pongiglione
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  89     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2003 Jan 
Date Detail:
Created Date:  2002-12-16     Completed Date:  2003-01-31     Revised Date:  2013-06-09    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  91-5     Citation Subset:  AIM; IM    
Affiliation:
Servizio di Cardiologia, Istituto G Gaslini Children's Hospital, Genoa, Italy.
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MeSH Terms
Descriptor/Qualifier:
Aortic Coarctation / complications,  surgery,  ultrasonography
Cardiac Pacing, Artificial / adverse effects,  methods*
Child
Child, Preschool
Coronary Angiography
Coronary Circulation
Echocardiography / adverse effects,  methods*
Echocardiography, Stress / adverse effects,  methods
Feasibility Studies
Heart Septal Defects, Ventricular / complications,  surgery,  ultrasonography
Humans
Infant
Sensitivity and Specificity
Transposition of Great Vessels / physiopathology*,  surgery,  ultrasonography*
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