Related Experiment Video
Updated: Jul 4, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Coronary flow before and after surgical versus device closure of atrial septal defect
Elhadi H Aburawi1, Ansgar Berg, Erkki Pesonen
1Department of Paediatrics, Division of Paediatric Cardiology, Lund University Hospital, Lund, Sweden, Gettingvägen, SE-221 85 Lund, Sweden. elhadi.aburawi@med.lu.se
Insights
Surgery involving cardiopulmonary bypass significantly alters coronary blood flow in children with atrial septal defects. Device closure, however, improves cardiac output without affecting coronary flow.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Interventional Cardiology
Background:
- Cardiopulmonary bypass (CPB) impacts post-operative coronary blood flow.
- Atrial septal defect (ASD) closure provides a model to study CPB effects on coronary flow.
Purpose of the Study:
- To compare the effects of surgical ASD closure with CPB versus device closure on coronary blood flow in children.
- To evaluate changes in cardiac output and coronary flow parameters after both procedures.
Main Methods:
- Transthoracic Doppler echocardiography used to measure coronary flow parameters before and after ASD closure.
- Study included 13 children undergoing surgical closure with CPB and 14 children with device closure.
- 14 age-matched healthy children served as controls.
Main Results:
- Surgical closure with CPB led to significant increases in left anterior descending and right coronary artery diameter, diastolic peak flow velocity, and basal blood flow.
- Device closure resulted in increased left ventricular fractional shortening and cardiac output.
- Coronary flow parameters decreased after device closure but remained elevated compared to controls.
Conclusions:
- Surgical closure with CPB affects coronary blood flow independently of anatomical correction.
- Device closure improves cardiac output but does not significantly alter coronary flow parameters.
- The observed decrease in coronary flow reserve after device closure is attributed to increased basal coronary flow.
Background:
Cardiopulmonary bypass (CPB) affects coronary flow after the operation. Surgical as compared to device closure of atrial septal defect (ASD) serves as a good model to clarify the effects of surgery with CPB on coronary flow.
Methods:
Coronary flow parameters were determined by transthoracic Doppler echocardiography before and after ASD closure. Thirteen children underwent surgery on CPB and fourteen children had device closure of their ASD under interventional cardiac catheterisation. Fourteen age-matched healthy controls were studied.
Results:
Left ventricular fractional shortening increased and cardiac output increased after the device closure but there were no significant changes after the surgery. After the surgery the mean diameter of left anterior descending coronary artery increased from 1.7 +/- 0.6 to 2.1 +/- 0.4 mm (p = 0.03), the peak flow velocity in diastole (PFVd) from 48 +/- 10 to 70 +/- 12 cm/s (p = 0.0001) and basal blood flow (BF) from 62 +/- 18 to 105 +/- 35 ml/min (p = 0.0001). Flow parameters in the right coronary artery increased similarly. In contrast, all coronary flow parameters decreased substantially after catheter interventions, but still remained significantly elevated as compared with controls.
Conclusions:
Surgery with cardiopulmonary bypass but not the device closure affects coronary flow beyond the pure effects of anatomical correction. Cardiac output increases after the device closure. The reported decrease of coronary flow reserve is obviously due to increased basal coronary flow.
