Related Experiment Video
Updated: Jun 10, 2026
A Rodent Model of The Ross Operation: Syngeneic Pulmonary Artery Graft Implantation in A Systemic Position
Published on: April 1, 2022
Coronary diameter and vasodilator function in children following arterial switch operation for complete transposition
Daniel R Turner1, Otto Muzik, Thomas J Forbes
1Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan, USA.
Insights
Coronary artery growth and function are generally normal in children after arterial switch operation (ASO). However, anomalies in the left anterior descending (LAD) artery may increase the risk of impaired myocardial flow reserve (MFR).
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Diagnostic Imaging
Background:
- Arterial switch operation (ASO) involves coronary artery reimplantation, potentially impacting coronary artery development and function in children.
- Assessing long-term coronary artery health after neonatal ASO is crucial for understanding surgical outcomes.
Purpose of the Study:
- To evaluate coronary artery diameter, myocardial blood flow (MBF), and myocardial flow reserve (MFR) in children following neonatal ASO.
- To identify potential risks associated with coronary artery reimplantation in pediatric patients.
Main Methods:
- Coronary angiograms were used to measure proximal coronary artery diameters in 12 children (median age 11 years) post-ASO.
- Cardiac positron emission tomography (PET) with nitrogen-13 ammonia assessed regional MBF at baseline and during adenosine hyperemia.
- Myocardial flow reserve (MFR) was calculated as the ratio of hyperemic to basal MBF.
Main Results:
- Coronary artery z-scores were within the normal range for most arteries (32/36).
- Normal MFR (>2.5) was observed in 10 out of 12 patients.
- Two patients with left anterior descending (LAD) anomalies (dual LAD or anomalous origin) showed impaired hyperemic MBF and low MFR (<2.5).
Conclusions:
- Coronary artery growth and function are typically normal in children after neonatal ASO.
- Anatomic variations of the LAD artery may predispose children to impaired MFR following ASO.
- Further monitoring is warranted for pediatric patients with coronary anomalies post-ASO.
Abstract:
Coronary reimplantation during arterial switch operation (ASO) may affect coronary artery growth and function during childhood. The purpose of this study was to assess coronary artery diameter and regional myocardial blood flow (MBF) and myocardial flow reserve (MFR) in children after neonatal ASO. We measured proximal diameters of left anterior descending (LAD), left circumflex, and posterior descending coronary arteries on coronary angiogram in 12 children (median age 11 years, range 7.6 to 15.1) with a history of neonatal ASO. These children then underwent cardiac positron emission tomographic imaging using nitrogen-13 ammonia to assess MBF at baseline and during intravenous adenosine hyperemia in regions supplied by these 3 coronary arteries. Coronary artery z-scores were within normal range (-2.0 to 2.0) for 32 of 36 coronary arteries. MFR (ratio of hyperemic to basal MBF) was normal (>2.5) in all myocardial regions in 10 of 12 patients. The remaining 2 patients, 1 with a dual LAD and 1 with LAD origin from the right coronary artery, had generalized impairment of hyperemic MBF (<2.0 ml/g/min) and low MFR (<2.5). Coronary artery z-scores and MFR in corresponding myocardial territories were not correlated (r = 0.15, p = 0.36). In conclusion, coronary growth and function appear to be normal in most children after neonatal ASO. Children with anatomic LAD abnormalities may be at increased risk of impaired MFR.
More Related Videos
13:10Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)
Published on: April 24, 2017
09:23Shunt Surgery, Right Heart Catheterization, and Vascular Morphometry in a Rat Model for Flow-induced Pulmonary Arterial Hypertension
Published on: February 11, 2017