Published Online
on September 3, 2002

A more recent version of this article appeared on September 24, 2002

This Article Full Text (PDF) All Versions of this Article: 106/13/1696    most recent 01.CIR.0000030937.27602.BDv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Oskarsson, G. Articles by Jögi, P. Search for Related Content PubMed Articles by Oskarsson, G. Articles by Jögi, P. Related Collections Coronary imaging: angiography/ultrasound/Doppler/CC Pediatric and congenital heart disease, including cardiovascular surgery

Submitted on March 18, 2002
Revised on July 11, 2002
Accepted on July 11, 2002

Normal Coronary Flow Reserve After Arterial Switch Operation for Transposition of the Great Arteries. An Intracoronary Doppler Guidewire Study

Gylfi Oskarsson MD^*, Erkki Pesonen MD, PhD, Peter Munkhammar MD, Staffan Sandström MD, and Peeter Jögi MD

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.

^* To whom correspondence should be addressed. 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

This article has been cited by other articles:

				S. M. Paridon, B. S. Alpert, S. R. Boas, M. E. Cabrera, L. L. Caldarera, S. R. Daniels, T. R. Kimball, T. K. Knilans, P. A. Nixon, J. Rhodes, et al. Clinical Stress Testing in the Pediatric Age Group: A Statement From the American Heart Association Council on Cardiovascular Disease in the Young, Committee on Atherosclerosis, Hypertension, and Obesity in Youth Circulation, April 18, 2006; 113(15): 1905 - 1920. [Abstract] [Full Text] [PDF]

				M. G. Gagliardi, R. Adorisio, F. Crea, P. Versacci, R. Di Donato, and S. P. Sanders Abnormal Vasomotor Function of the Epicardial Coronary Arteries in Children Five to Eight Years After Arterial Switch Operation: An Angiographic and Intracoronary Doppler Flow Wire Study J. Am. Coll. Cardiol., October 18, 2005; 46(8): 1565 - 1572. [Abstract] [Full Text] [PDF]

				S. R.F.F. Pedra, C. A.C. Pedra, A. A. Abizaid, S. L.N. Braga, R. Staico, R. Arrieta, J. R. Costa Jr, V. D. Vaz, V. F. Fontes, and J. E. R. Sousa Intracoronary Ultrasound Assessment Late After the Arterial Switch Operation for Transposition of the Great Arteries J. Am. Coll. Cardiol., June 21, 2005; 45(12): 2061 - 2068. [Abstract] [Full Text] [PDF]

				M. Hauser, A. Kuehn, J. Hess, G. Oskarsson, E. Pesonen, P. Munkhammar, S. Sandstrom, and P. Jogi Myocardial Perfusion in Patients With Transposition of the Great Arteries After Arterial Switch Operation * Reply Circulation, May 13, 2003; 107 (18): e126 - e126. [Full Text] [PDF]