Published online before print September 3, 2002, doi: 10.1161/01.CIR.0000030937.27602.BD
(Circulation. 2002;106:1696.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Normal Coronary Flow Reserve After Arterial Switch Operation for Transposition of the Great Arteries
An Intracoronary Doppler Guidewire Study
From the Departments of Pediatric Cardiology (G.O., E.P., P.M.), Radiology (S.S.), and Cardiothoracic Surgery (P.J.), University Hospital of Lund, Sweden.
Correspondence to Gylfi Oskarsson, MD, Department of Pediatric Cardiology, Lund University Hospital, S-221 85 Lund, Sweden. E-mail oggylfi{at}hn.is
Background— Recent studies performed with positron emission tomography have suggested that coronary flow reserve (CFR) is moderately to severely reduced after the arterial switch operation (ASO). These findings are of great concern but have not been confirmed by other methods.
Methods and Results— Eleven symptom-free children were studied between 4 and 11 (median 6.0) years after the ASO. Flow velocity in the left anterior descending (LAD) and right coronary arteries (RCA) was measured with a 0.014-inch Doppler FloWire (Cardiometrics) before and after intracoronary injection of adenosine (0.5 µg/kg) and nitroglycerin (5 µg/kg). CFR was defined as the ratio of hyperemic to basal average peak velocity (APV). The median (range) CFR in the LAD was 3.7 (3.0 to 4.8) and 3.4 (2.9 to 4.8) in the RCA. The increase in APV after intracoronary injection of nitroglycerin was 300% (240% to 420%) in the LAD and 260% (190% to 460%) in the RCA. APV at rest was 15.0 (14.0 to 21.0) cm/s in the LAD and 16.0 (9.6 to 30.0) cm/s in the RCA. A linear relation was found between right ventricular systolic pressure and resting APV in the RCA (r=0.77, P=0.0056), and between resting APV and CFR (r=-0.61, P<0.05) in the RCA.
Conclusions— The CFR and coronary vasoreactivity to nitroglycerin in children treated for transposition of the great arteries with the ASO was within normal limits. Increased right ventricular pressure and myocardial hypertrophy can cause increased resting coronary flow velocity in the RCA and affect CFR negatively.
Key Words: transposition of the great vessels • surgery • adenosine • blood flow
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