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Published on: August 16, 2019
Left anterior descending coronary artery flow and its relation to age in children
Kenji Yasuoka1, Kenji Harada, Masamichi Tamura
1Department of Pediatrics, Akita University School of Medicine, Japan.
Insights
Transthoracic Doppler echocardiography reliably measures coronary blood flow in children. Infants have high left anterior descending coronary artery flow, which decreases with age, indicating high myocardial perfusion.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Imaging
- Echocardiography
Background:
- Coronary flow dynamics assessment in children is advancing with Doppler and color echocardiography.
- Quantitative estimation of coronary blood flow is crucial for understanding pediatric cardiovascular health.
Purpose of the Study:
- To quantitatively assess left anterior descending coronary artery (LAD) volumetric flow in healthy children.
- To determine the relationship between LAD flow, age, and left ventricular (LV) mass.
- To validate Doppler echocardiography for reliable LAD flow measurement in a clinical pediatric setting.
Main Methods:
- High-frequency transthoracic echocardiography was used in 57 healthy children.
- 2D echocardiography measured LAD diameter, cross-sectional area, and LV mass.
- Doppler echocardiography measured LAD peak flow velocity, flow velocity integral, and flow volume.
- Calculated LAD cross-sectional area/LV mass and LAD flow volume/LV mass ratios.
- Compared Doppler echocardiography with Doppler guidewire in 12 Kawasaki disease patients.
Main Results:
- Significant correlations found between echocardiographic and Doppler guidewire methods for flow velocity (r=0.77) and flow velocity integral (r=0.83).
- LAD flow velocity decreased significantly with age (r=-0.43).
- LAD flow volume per minute increased significantly with age (r=0.55).
- LAD flow volume/LV mass ratio was high in infants and decreased significantly with age (r=-0.66).
Conclusions:
- Transthoracic Doppler echocardiography reliably assesses LAD flow patterns in most pediatric subjects.
- High LAD flow velocity and LAD flow volume/LV mass ratio in infants suggest high myocardial perfusion.
- Age-related changes in LAD flow characteristics are essential considerations for pediatric coronary circulation studies.
Abstract:
Recent advances in Doppler and color echocardiographic techniques enable coronary flow dynamics to be estimated even in children. To assess quantitatively left anterior descending coronary artery (LAD) volumetric flow and to determine its relation to age and left ventricular (LV) mass, healthy children participated in a study that used high-frequency transthoracic echocardiography. We also studied whether Doppler echocardiography can reliably measure LAD flow in a clinical setting. In 57 healthy children, 2-dimensional echocardiography was used to measure the diameter and cross-sectional area of the LAD and LV mass. LAD peak flow velocity, flow velocity integral, and flow volume were measured by Doppler echocardiography. We then calculated the ratio of LAD cross-sectional area to LV mass and the ratio of LAD flow volume to LV mass. In 12 patients with Kawasaki disease, LAD flow velocity and flow velocity integral were measured by Doppler echocardiography at the time of Doppler guide wire examination. There were significant correlations between echocardiographic and Doppler guide wire methods for flow velocity and flow velocity integral (r = 0.77 and 0.83, P <.01, respectively). The LAD flow velocity decreased significantly with age (r = -0.43, P <.01). The LAD flow volume per minute increased significantly with age (r = 0.55, P <.01). However, LAD flow volume/LV mass ratio in younger infants was high and decreased significantly with age (r = -0.66, P <.01). This study shows that LAD flow patterns can be reliably assessed by transthoracic Doppler echocardiography in the majority of pediatric subjects. In the current study, the LAD flow velocity and the ratio of LAD flow volume to LV mass in infants was high and decreased with age, suggesting high myocardial perfusion. High LAD peak velocity in infants may be related with high resting coronary flow. Age-related changes in the LAD flow characteristics must be taken into consideration in the study of the coronary circulation in children.
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