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Moscatelli S, Avesani M, Borrelli N, Sabatino J, Pergola V, Leo I, Montanaro C, Contini FV, Gaudieri G, Ielapi J, Motta R, Merrone MA, Di Salvo G. Complete Transposition of the Great Arteries in the Pediatric Field: A Multimodality Imaging Approach. CHILDREN (BASEL, SWITZERLAND) 2024; 11:626. [PMID: 38929206 PMCID: PMC11202141 DOI: 10.3390/children11060626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/07/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024]
Abstract
The complete transposition of the great arteries (C-TGA) is a congenital cardiac anomaly characterized by the reversal of the main arteries. Early detection and precise management are crucial for optimal outcomes. This review emphasizes the integral role of multimodal imaging, including fetal echocardiography, transthoracic echocardiography (TTE), cardiovascular magnetic resonance (CMR), and cardiac computed tomography (CCT) in the diagnosis, treatment planning, and long-term follow-up of C-TGA. Fetal echocardiography plays a pivotal role in prenatal detection, enabling early intervention strategies. Despite technological advances, the detection rate varies, highlighting the need for improved screening protocols. TTE remains the cornerstone for initial diagnosis, surgical preparation, and postoperative evaluation, providing essential information on cardiac anatomy, ventricular function, and the presence of associated defects. CMR and CCT offer additional value in C-TGA assessment. CMR, free from ionizing radiation, provides detailed anatomical and functional insights from fetal life into adulthood, becoming increasingly important in evaluating complex cardiac structures and post-surgical outcomes. CCT, with its high-resolution imaging, is indispensable in delineating coronary anatomy and vascular structures, particularly when CMR is contraindicated or inconclusive. This review advocates for a comprehensive imaging approach, integrating TTE, CMR, and CCT to enhance diagnostic accuracy, guide therapeutic interventions, and monitor postoperative conditions in C-TGA patients. Such a multimodal strategy is vital for advancing patient care and improving long-term prognoses in this complex congenital heart disease.
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Affiliation(s)
- Sara Moscatelli
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London WC1E 6BT, UK
- Paediatric Cardiology Department, Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London SW3 5NP, UK
| | - Martina Avesani
- Division of Paediatric Cardiology, Department of Women and Children’s Health, University Hospital of Padua, 35128 Padua, Italy
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, AO Dei Colli-Monaldi Hospital, 80131 Naples, Italy
| | - Jolanda Sabatino
- Experimental and Clinical Medicine Department, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy (I.L.)
| | - Valeria Pergola
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, University Hospital of Padua, 35128 Padua, Italy; (V.P.)
| | - Isabella Leo
- Experimental and Clinical Medicine Department, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy (I.L.)
| | - Claudia Montanaro
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London SW3 5NP, UK
- CMR Unit, Cardiology Department, Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London SW3 5NP, UK
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Francesca Valeria Contini
- Clinical Cardiology Unit, Department of Medical Sciences and Public Health, University Hospital of Cagliari, Strada Statale 554, Km 4.500, 09042 Monserrato, Italy
- Pediatric Cardiology and Congenital Heart Disease Unit, Brotzu Hospital, 09134 Cagliari, Italy
| | - Gabriella Gaudieri
- Adult Congenital Heart Disease Unit, AO Dei Colli-Monaldi Hospital, 80131 Naples, Italy
| | - Jessica Ielapi
- Experimental and Clinical Medicine Department, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy (I.L.)
| | - Raffaella Motta
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, University Hospital of Padua, 35128 Padua, Italy; (V.P.)
| | - Marco Alfonso Merrone
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
- Division of Cardiology and Cardio Lab, Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Giovanni Di Salvo
- Division of Paediatric Cardiology, Department of Women and Children’s Health, University Hospital of Padua, 35128 Padua, Italy
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Cotrim N, Café HM, Guardado J, Cordeiro P, Cotrim H, Martins R, Baquero L, Cotrim C. Clinical Application of Exercise Stress Echocardiography in an Outpatient Pediatric Population. J Clin Med 2024; 13:2191. [PMID: 38673464 PMCID: PMC11050833 DOI: 10.3390/jcm13082191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Exercise stress echocardiography (ESE) is commonly employed in adults, but its applicability in pediatric populations remains to be clarified. Methods: A total of 309 consecutive children (C), with a mean age of 14.1 ± 2.6 years (range 6-17 years), underwent treadmill ESE starting in 2002. They were divided into two groups: Group I comprised 258 children, including 237 with symptoms related to exercise (such as chest pain, fatigue, lipothymia/syncope, or one aborted sudden death), 15 with electrocardiogram (ECG) abnormalities, and 6 with a positive ECG stress test showing ST changes. Group II consisted of 10 asymptomatic children whose parents requested routine screening, 11 with symptoms unrelated to exercise, 12 with a family history of sudden death, and 17 with known pathologies (including 10 with hypertrophic cardiomyopathy, 2 with aortic coarctation, and the remainder with various conditions, such as Cortriatriatum sinister, pulmonary stenosis, subaortic stenosis, bicuspid aortic valve, left ventricular hypertrophy related to arterial hypertension, and aortic switch operation). Regional wall motion abnormalities (RWMAs) and transvalvular or intraventricular (IVG) gradients were assessed using 2D and continuous-wave Doppler, respectively, in all cases. Results: The success rate was 100% (309/309). Stress-induced RWMAs were observed in two children. A significant IVG (>30 mmHg) was detected in 101 out of the 258 children (39%) in Group I, who presented with exercise-related symptoms, ECG abnormalities, or positive stress ECG. In Group I, the odds ratio (OR) of ESE reproducing the symptoms in children with IVG compared to those without IVG was 8.22 (95% CI: 4.84-13.99, p < 0.001). Conclusions: Treadmill ESE is both feasible and safe for pediatric populations. RWMAs demonstrated limited utility in our cohort of children, while IVG induced by exercise was frequently observed in symptomatic children.
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Affiliation(s)
- Nuno Cotrim
- Hospital Distrital de Santarém, 2005-177 Santarém, Portugal;
- Heart Center do Hospital da Cruz Vermelha, 1500-048 Lisboa, Portugal; (J.G.); (L.B.)
- Unidade Cardiovascular, 2350-325 Torres Novas, Portugal
| | - Hugo M. Café
- Hospital Particular do Algarve, 8005-226 Faro, Portugal (P.C.)
| | - Jorge Guardado
- Heart Center do Hospital da Cruz Vermelha, 1500-048 Lisboa, Portugal; (J.G.); (L.B.)
- Unidade Cardiovascular, 2350-325 Torres Novas, Portugal
| | - Pedro Cordeiro
- Hospital Particular do Algarve, 8005-226 Faro, Portugal (P.C.)
| | | | - Rui Martins
- Faculdade de Ciências de Lisboa, Universidade de Lisboa, 1749-016 Lisboa, Portugal;
| | - Luís Baquero
- Heart Center do Hospital da Cruz Vermelha, 1500-048 Lisboa, Portugal; (J.G.); (L.B.)
| | - Carlos Cotrim
- Heart Center do Hospital da Cruz Vermelha, 1500-048 Lisboa, Portugal; (J.G.); (L.B.)
- Unidade Cardiovascular, 2350-325 Torres Novas, Portugal
- Hospital Particular do Algarve, 8005-226 Faro, Portugal (P.C.)
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Chalverat M, Bouchardy J, Blanche C, Pruvot E, Sekarski N, Yerly P, Rutz T. The role of exercise testing in congenital heart disease patients after coronary artery reimplantation. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Dasgupta S, Friedman H, Allen N, Stark M, Ferguson E, Sachdeva R, Border WL. Exercise stress echocardiography: Impact on clinical decision-making in pediatric patients. Echocardiography 2019; 36:938-943. [PMID: 30934142 DOI: 10.1111/echo.14326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/21/2019] [Accepted: 03/06/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The role of exercise stress echocardiography (ESE) in the pediatric population is less well defined as compared to adults. We aimed to determine the utility and impact of ESE on clinical decision-making in pediatric patients. METHODS We identified patients who underwent an ESE at our center from 2011 to 2015. Test indications were categorized into symptoms with exercise; sports/activity clearance; hypertrophic cardiomyopathy (HCM) or suspected HCM; coronary anomalies; or abnormal electrocardiogram (EKG). Change in clinical management was assessed by comparing pre- and post-test activity restrictions, which were categorized into unrestricted from exercise or activity; restricted from exercise or activity; and surgical referral. RESULTS During the study period, 353 ESEs met inclusion criteria. Of all ESEs performed, 263 (75%) were normal. Clinical management changed as a result of ESE in 144 (40%). Of the abnormal ESEs, 44 were restricted from activity, including 25 (56.8%) restricted from competitive or varsity athletics, 14 (31.8%) restricted from recreational sports, and 5 (11.4%) restricted from all activity. Surgical referrals included valve repair/replacement in 7 (50%), ICD placement in 5 (35.8%), coronary re-implantation in 1 (7.1%), and atrial septal defect repair in 1 (7.1%). CONCLUSION Exercise stress echocardiography provides the pediatric cardiologist with useful information that impacts management in a wide variety of cardiac disorders. Clinical management changed in nearly half the patients that were subjected to an ESE at our center. This supports the value of ESE for informing clinical decision-making. Future studies should aim to refine patient selection and examine its impact on patient outcomes.
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Affiliation(s)
- Soham Dasgupta
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | | | - Nicole Allen
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Megan Stark
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Eric Ferguson
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Ritu Sachdeva
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - William L Border
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
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