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Published on: April 7, 2022
Coronary flow velocity and coronary flow velocity reserve in children with ventricular septal defect
Kenja Harada1, Mieko Aoki, Manatomo Toyono
1Department of Pediatrics, Akita University School of Medicine, Akita 010-8543, Japan. kharada@doc.med.akita-u-ac.jp
Insights
Coronary flow velocity reserve (CFVR) is reduced in children with left ventricular (LV) volume overload due to elevated baseline flow. Surgical correction improves CFVR by lowering resting flow in the left anterior descending coronary artery.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Physiology
- Congenital Heart Disease
Background:
- Left ventricular (LV) volume overload is common in congenital heart defects, such as ventricular septal defect.
- Assessing coronary flow characteristics is crucial for understanding the impact of LV volume overload on myocardial perfusion.
- Previous studies have not fully elucidated the coronary flow dynamics in this specific pediatric population.
Purpose of the Study:
- To evaluate coronary flow characteristics, specifically coronary flow velocity reserve (CFVR), in children with LV volume overload.
- To determine the relationship between LV volume overload severity and coronary flow parameters.
- To assess the impact of surgical intervention on coronary flow in these patients.
Main Methods:
- Studied 24 children with ventricular septal defect (VSD) and LV volume overload, comparing them to 10 age-matched controls.
- Measured average peak flow velocity (APV) in the left anterior descending coronary artery (LAD) at rest and during hyperemia using Doppler flow wire.
- Calculated CFVR (hyperemic/baseline APV) and analyzed correlations with pulmonary to systemic flow ratio (Qp/Qs), LV end-diastolic volume, and LV mass.
Main Results:
- Patients with LV volume overload had significantly reduced CFVR (1.78) compared to controls (2.66) (p < .0001).
- This reduction was attributed to significantly higher baseline APV in the VSD group (30 cm/sec vs. 23 cm/sec) (p = 0.0027).
- Baseline APV and Qp/Qs were significant determinants of CFVR, with improved CFVR post-surgery due to reduced baseline APV.
Conclusions:
- CFVR is impaired in pediatric patients with LV volume overload, primarily due to elevated resting coronary flow.
- The degree of LV volume overload and associated pulmonary to systemic flow ratio directly influence LAD flow patterns.
- Surgical correction of VSD can lead to significant improvement in CFVR by normalizing baseline coronary artery flow.
Abstract:
To assess coronary flow characteristics in congenital heart defect with left ventricular (LV) volume overload, we examined 24 children (mean 12.1 +/- 7.1 months) with ventricular septal defect. The pulmonary to systemic flow ratio ranged from 1.1 to 3.0. Control group consisted of 10 age-matched children who had a history of Kawasaki disease with angiographically normal coronary artery in the acute phase. LV end-diastolic volume and LV mass were measured by left ventriculogram. With Doppler flow guide wire (0.014-inch), average peak flow velocity (APV) in left anterior descending coronary artery was recorded at rest and during hyperemia (0.16 mg/kg/min adenosine infusion intravenously). Coronary flow velocity reserve (CFVR) was calculated as the ratio of hyperemic/baseline APV. Seven patients were also studied 5-7 months after surgery. Compared with control subjects, CFVR was significantly reduced in patients with LVvolume overload (1.78 +/- 0.24 vs. 2.66 +/- 0.42, p < .0001) because baseline APV was significantly greater (30 +/- 8 vs. 23 +/- 5 cm/sec, p = 0.0027). Significant correlations were observed between CFVR and Qp/Qs, baseline APV, LV end-diastolic volume, or LVmass. Stepwise regression analysis showed that baseline APV and Qp/Qs were important determinants of CFVR (CFVR = 2.64-0.202 [Qp/Qs]-0.015 [APV] r = 0.83, p < 0.0001). In 7 patients with LVvolume overload, CFVR improved significantly after surgery because of reduction of baseline APV. CFVR is limited in patients with LV volume overload because of the elevation of baseline resting APV. LAD flow pattern is dependent on LV volume overload level and its changes after surgery.
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