Circulation, Vol 86, 38-46, Copyright © 1992 by American Heart Association
K Rakusan, MF Flanagan, T Geva, J Southern and R Van Praagh
BACKGROUND. In adults, acquired pressure-overload left ventricular
hypertrophy can result in myocardial ischemia, which may be due in part to
insufficient capillary growth during development of hypertrophy. The
coronary microvascular response to congenital pressure-overload hypertrophy
in children has not been previously characterized. METHODS AND RESULTS.
Average capillary density and heterogeneity of capillary spacing were
measured in 63 postmortem human hearts with left ventricular hypertrophy
and control hearts without heart disease. Pathology specimens were chosen
that had left ventricular hypertrophy caused by 1) congenital isolated
aortic valve stenosis in infants less than 1 year old at death, children
9-14 years old, and adults 15-30 years old; 2) congenital isolated
coarctation of the aorta in adults 15- 39 years old; and 3) acquired aortic
stenosis in adults 51-86 years old. Major findings of the study were: 1)
Human left ventricular capillary density and heterogeneity of capillary
spacing are similar to other mammalian species. 2) Capillary density is
higher in infants (3,315 +/- 85 capillaries per square millimeter),
decreases with increasing heart weight during normal growth in early
childhood (children, 2,388 +/- 75 capillaries per square millimeter, p less
than 0.05), and thereafter remains relatively constant. 3) Capillary
density with left ventricular hypertrophy is dependent on the age of onset.
Congenital aortic stenosis and coarctation are characterized by an increase
in capillary supply proportional to myocyte volume, maintaining capillary
density similar to control hearts. Adults with acquired aortic stenosis
have decreased capillary density (1,671 +/- 66 capillaries per square
millimeter, p less than 0.01 versus control). CONCLUSIONS.
Pressure-overload left ventricular hypertrophy in children demonstrates
proportional capillary angiogenesis, whereas in adults, hypertrophy appears
to be associated with failure of compensatory angiogenesis.
ARTICLES
Morphometry of human coronary capillaries during normal growth and the effect of age in left ventricular pressure-overload hypertrophy
Department of Physiology, University of Ottawa, School of Medicine, Ontario, Canada.
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