This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2005.06.065v1 46/8/1565    most recent 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 Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gagliardi, M. G. Articles by Sanders, S. P. Search for Related Content PubMed PubMed Citation Articles by Gagliardi, M. G. Articles by Sanders, S. P.

CLINICAL RESEARCH

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

Maria Giulia Gagliardi, MD, PhD^_*,_*, Rachele Adorisio, MD^_*, Filippo Crea, MD, Paolo Versacci, MD^_*, Roberto Di Donato, MD^_* and Stephen P. Sanders, MD, FACC^_*

^_* Ospedale Bambino Gesù
Policlinico Universitario A. Gemelli Università La Cattolica, Rome, Italy

Manuscript received March 15, 2005; revised manuscript received May 30, 2005, accepted June 20, 2005.

^_* Reprint requests and correspondence: Dr. Maria Giulia Gagliardi, Dipartimento Medico-Chirurgico di Cardiologia Pediatrica, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio, 4, 00165 Rome, Italy (Email: gagliard{at}opbg.net).

OBJECTIVES: This study sought to test the vasoreactivity of the translocated coronary arteries after arterial switch operation (ASO) using quantitative angiographic analysis and intracoronary Doppler flow wire velocimetry.

BACKGROUND: Late coronary artery events occur in 3% to 8% of patients after the ASO. Previous studies of coronary flow reserve have yielded disparate results.

METHODS: Nineteen children previously underwent ASO (13 boys, age 5.4 ± 3.2 years, weight 22.3 ± 10.6 kg), and six control patients were enrolled in the study. Each patient underwent quantitative angiographic assessment of the epicardial coronary arteries before and after administration of nitroglycerin and coronary blood flow volume assessment before and after administration of adenosine and acetylcholine. The results were compared between groups.

RESULTS: Epicardial coronary artery dilation in response to intracoronary nitroglycerin was significantly less in the ASO group than in the control group (left anterior descending [LAD], 5.0 ± 0.05% vs. 18.0 ± 4.5%, p = 0.0009; right coronary artery [RCA], 4.0 ± 0.07% vs. 32.7 ± 12.7%, p = 0.006). Moreover, the coronary blood flow volume reserve was reduced in ASO patients compared with control patients after intracoronary infusion of acetylcholine (2.3 ± 0.9 vs. 4.9 ± 1.7, p = 0.0003) or adenosine (2.7 ± 1.5 vs. 5 ± 0.5, p = 0.002).

CONCLUSIONS: Epicardial coronary arteries fail to dilate normally in children after ASO, and the calculated coronary flow volume reserve is consequently reduced.

Abbreviations and Acronyms   APV = average peak velocity   ASO = arterial switch operation   CFR = coronary volume flow reserve   CSA = cross-sectional area   CVFR = coronary velocity flow reserve   LAD = left anterior descending artery   LAO = left anterior oblique   LCA = left coronary artery   PET = positron emission tomography   RAO = right anterior oblique   RCA = right coronary artery

This article has been cited by other articles:

				E. H. Aburawi, A. Berg, P. Liuba, and E. Pesonen Effects of cardiopulmonary bypass surgery on coronary flow in children assessed with transthoracic Doppler echocardiography Am J Physiol Heart Circ Physiol, August 1, 2007; 293(2): H1138 - H1143. [Abstract] [Full Text] [PDF]

				R.-E. W. Kavey, V. Allada, S. R. Daniels, L. L. Hayman, B. W. McCrindle, J. W. Newburger, R. S. Parekh, and J. Steinberger Cardiovascular Risk Reduction in High-Risk Pediatric Patients: A Scientific Statement From the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: Endorsed by the American Academy of Pediatrics Circulation, December 12, 2006; 114(24): 2710 - 2738. [Abstract] [Full Text] [PDF]

				A. N. DeMaria, O. Ben-Yehuda, D. Berman, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, W. Y.W. Lew, D. Sahn, and S. Tsimikas Highlights of the Year in JACC 2005 J. Am. Coll. Cardiol., January 3, 2006; 47(1): 184 - 202. [Full Text] [PDF]