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Published on: April 13, 2015
Pathophysiology of coronary blood flow in congenital heart disease
Elhadi H Aburawi1, Erkki Pesonen
1Department of Pediatrics, Division of Pediatric Cardiology, Lund University, Lund, Sweden. e.aburawi@uaeu.ac.ae
Insights
Coronary flow (CF) increases in children with congenital heart disease (CHD), especially with coarctation of the aorta (CoA). Increased coronary perfusion pressure is key in newborns, while inflammation reduces CF.
Area of Science:
- Cardiovascular Science
- Pediatric Cardiology
- Medical Imaging
Background:
- Congenital heart disease (CHD) significantly impacts coronary flow (CF), but these effects are not well understood.
- Understanding these impacts is crucial for managing pediatric cardiovascular conditions.
Purpose of the Study:
- To investigate how volume/pressure overload and elevated coronary perfusion pressure affect coronary flow (CF) in children with congenital heart disease (CHD).
Main Methods:
- Transthoracic Doppler echocardiography was used to assess 65 children with acyanotic CHD and 49 healthy controls.
- Coronary flow (CF) was measured in specific arteries based on the type of CHD, including ventricular septal defect (VSD), atrial septal defect (ASD), pulmonary stenosis (PS), and coarctation of the aorta (CoA).
- CF data were normalized as a percentage of the median values from age-matched healthy controls.
Main Results:
- Coronary flow (CF) was significantly elevated in patients with VSD (172%), ASD (185%), PS (233%), and particularly CoA (773%) compared to controls.
- In coarctation of the aorta (CoA) patients, CF correlated with body surface area, blood pressure, systolic wall tension, and inflammation markers (C-reactive protein).
- Inflammation was found to decrease coronary flow (CF).
Conclusions:
- Coronary flow (CF) increases were most pronounced in coarctation of the aorta (CoA) patients.
- Elevated coronary perfusion pressure appears to be a primary driver of increased CF in newborns with CHD.
- Inflammation negatively impacts coronary flow (CF) in pediatric patients with CHD.
Objectives:
The aim was to investigate the effects of volume and pressure overload and increased coronary perfusion pressure on coronary flow (CF) in congenital heart disease (CHD) patients.
Background:
The effects of CHD on CF are poorly mapped.
Methods:
A total of 65 patients with acyanotic CHD and 49 age-matched healthy controls were examined by transthoracic Doppler echocardiography. Posterior descending artery flow was measured in patients with pulmonary valve stenosis (PS) and atrial septal defects (ASDs) i.e. in lesions with right ventricular pressure or volume overload, and left anterior descending artery flow in patients with coarctation of the aorta (CoA) and ventricular septal defect (VSD), in lesions with left ventricular pressure or volume overload. The CF data in each patient group were expressed as the percent of the median for healthy controls from the same age group.
Results:
The CF values were in VSD 172%, ASD 185%, PS 233%, and CoA 773% patients. In CoA patients body surface area (r=0.90, p<0.0001), systolic blood pressure (r=0.72, p<0.0001), diastolic blood pressure (r=0.77, p<0.0001), systolic wall tension (r=-0.77, p=0.004), and signs of inflammation (log CRP, r=-0.75, p=0.007) correlated with CF.
Conclusions:
The increase in CF and velocity was most significant in patients with CoA. In newborns, increased coronary perfusion pressure seems to be the most important factor for increased CF, even if the pressure is not assumed to cause a significant increase in flow over the auto-regulatory range of 70-130mmHg. We also showed that inflammation decreases CF.
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