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Aortic reservoir function after arterial switch operation in elementary school-aged children
Tomoaki Murakami1, Kohta Takei, Michihiko Ueno
1Department of Pediatrics, Hokkaido University, Graduate School of Medicine, Sapporo, Japan. murat@med.hokudai.ac.jp
Insights
Pediatric patients who underwent arterial switch operation (ASO) showed impaired aortic root distensibility but maintained normal coronary supply-demand balance. Aortic dilatation may compensate for reservoir function, necessitating careful cardiovascular follow-up.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Aortic Physiology
Background:
- Arterial switch operation (ASO) can lead to decreased aortic root distensibility, impairing aortic reservoir function.
- The relationship between aortic reservoir function and myocardial perfusion post-ASO is not well understood.
Purpose of the Study:
- To examine aortic reservoir function and coronary supply-demand balance in pediatric patients post-ASO.
- To investigate the impact of aortic root dysfunction on myocardial perfusion after ASO.
Main Methods:
- Measured diastolic runoff (DR) as an index of aortic reservoir function.
- Assessed subendocardial viability ratio for coronary supply-demand balance.
- Compared patients post-ASO with an age-matched control group.
Main Results:
- Patients post-ASO exhibited aortic root dilation and impaired distensibility compared to controls.
- No significant differences were found in diastolic runoff or subendocardial viability ratio between groups.
- Coronary supply-demand balance was preserved in pediatric ASO patients despite aortic root dysfunction.
Conclusions:
- Aortic dilatation appears to compensate for impaired aortic reservoir function post-ASO.
- Coronary perfusion is maintained in pediatric patients following ASO, irrespective of aortic root dysfunction.
- Large artery dysfunction post-ASO warrants careful long-term cardiovascular monitoring.
Background:
After the arterial switch procedure, decreased distensibility of the aortic root has been reported, which means impaired aortic reservoir function of the coronary circulation, but there have been no reports regarding the relationship of this issue to myocardial perfusion. Therefore, in the present study the aortic reservoir function and coronary supply-demand balance were examined in patients after undergoing the arterial switch operation (ASO) around the time of entering elementary school.
Methods And Results:
Diastolic runoff (DR), which is the percentage of diastolic blood flow to total cardiac output, was measured as the index of aortic reservoir function. The subendocardial viability ratio was investigated as the index of coronary supply - demand balance. In the patient group, the aortic root was dilated (p<0.0001) and distensibility was impaired (p<0.0001) in comparison with an age-matched control group. However, there was no difference between the 2 groups in DR or subendocardial viability ratio.
Conclusions:
Coronary supply - demand balance was preserved in the pediatric ASO patients, despite the aortic root dysfunction. The preserved DR suggests that dilatation of the aorta compensates for aortic reservoir function. Because large artery dysfunction predicts future cardiovascular diseases, careful follow-up is crucial.
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