Myocardial perfusion and viability by positron emission tomography in infants and children with coronary abnormalities correlation with echocardiography,coronary angiography, and histopathology

AbstractObjectivesThis study was designed to assess the feasibility and accuracy of positron emission tomography (PET) imaging in infants and children.BackgroundPositron emission tomography is employed in adults for the evaluation of myocardial perfusion and the detection of myocardial viability.MethodsPerfusion and metabolism findings on PET in infants and children with suspected coronary abnormalities (age 14 days to 12 years old, mean 3.3 ± 4.0 years) were correlated with findings on coronary angiography, echocardiography, and myocardial histopathology. The segmental myocardial uptake of the flow tracer 13N-ammonia and of the glucose tracer 18F-deoxyglucose (18FDG) was graded on a five-point scale and compared with the angiographic perfusion score, with regional wall motion, and the presence of fibrosis.ResultsThere was an agreement of r = 0.72 (p < 0.05) between regional myocardial perfusion and angiography. The correlation of histopathologic changes with normal, moderately, and severely reduced segmental 13N-ammonia uptake was 87%, 60%, and 75%, respectively. Segmental myocardial 18FDG uptake and histopathologic findings were concordant in 48 (79%) of 64 segments without fibrosis; absence of viability by perfusion and metabolism imaging correlated with the presence of fibrosis in 21 (84%) of 25 segments.ConclusionsThe observed agreements between the findings on PET perfusion and metabolism imaging with those on coronary angiography, echocardiography, and histopathology support the utility and accuracy of PET for characterizing myocardial perfusion abnormalities and viability in pediatric patients

Transthoracic echocardiographic guidance of transcatheter atrial septal defect closure

This study examines the safety and efficacy of transthoracic echocardiographic (TTE) guidance of atrial septal defect (ASD) device closure. We evaluated 74 patients for TTE-guided ASD closure. Fifty-six patients had successful device implantation using TTE guidance. Twelve patients were referred for surgical ASD closure on the basis of TTE evaluation. Five patients with multiple ASDs or poor transthoracic acoustic windows had ASD device closure guided by transesophageal echocardiography (TEE)