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Coronary flow dynamics in children after repair of Tetralogy of Fallot
Elhadi H Aburawi1, Peter Munkhammar2, Marcus Carlsson3
1Departments of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, United Arab Emirates; Departments of Pediatric Cardiology, Skåne University Hospital, Lund University, Sweden.
Insights
Post-operative Tetralogy of Fallot (TOF) patients show increased coronary flow, particularly with right ventricular (RV) fibrosis and RV restrictive physiology. This finding highlights potential impacts on myocardial perfusion after surgical correction.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Cardiac Physiology
Background:
- Tetralogy of Fallot (TOF) repair can lead to right ventricular (RV) dysfunction.
- Right ventricular restrictive physiology (RVRP), characterized by forward flow during atrial contraction, is common post-TOF repair.
- Understanding RV impact on coronary circulation is crucial for long-term patient management.
Purpose of the Study:
- To investigate the relationship between a stiff right ventricle and coronary flow (CF) in post-operative Tetralogy of Fallot (TOF) patients.
- To assess if right ventricular restrictive physiology (RVRP) influences coronary artery blood flow.
- To evaluate the impact of myocardial fibrosis on coronary flow in this cohort.
Main Methods:
- 34 post-operative TOF patients (mean age 10.2 ± 2.8 years) and 20 healthy controls were studied.
- Transthoracic Doppler echocardiography assessed coronary flow in the posterior descending (PDCA) and left anterior descending (LAD) arteries.
- Cardiac magnetic resonance (CMR) imaging evaluated RV volumes, RVRP, and myocardial fibrosis.
Main Results:
- TOF patients exhibited increased diastolic peak flow velocity and flow velocity time integral compared to controls.
- Increased LAD coronary flow was observed in patients with RV fibrosis and RVRP.
- RV end-diastolic and end-systolic volumes were larger in patients with RVRP.
Conclusions:
- Mid-term follow-up after TOF correction reveals elevated coronary flow.
- The increase in coronary flow is more pronounced in TOF patients with RV fibrosis and RVRP.
- These findings suggest RV mechanics significantly influence coronary perfusion post-TOF repair.
Objectives:
To assess the possible effect of a stiff right ventricle on the coronary flow (CF) in patients with post-operative Tetralogy of Fallot (TOF).
Background:
Right ventricular restrictive physiology i.e. forward flow during atrial contraction (RVRP), is characteristic to many patients with post-operative TOF.
Methods:
A total of 34 patients with TOF anatomically corrected through transatrial repair were included. Coronary flow parameters were registered with transthoracic Doppler echocardiography from posterior descending (PDCA) and left anterior descending (LAD) coronary arteries in the same patient in 24/34 (71%) patients. Twenty age-matched healthy children were used as controls. Cardiac magnetic resonance (CMR) imaging was used to detect myocardial fibrosis, RV volume, and RVRP.
Results:
The mean age at investigation was 10.2 ± 2.8 years. RV end diastolic and end systolic volumes indexed for BSA were larger in patients with RVRP (p=0.002 and 0.008 respectively). Peak flow velocity in diastole and flow velocity time integral was increased in patients compared to controls. They were increased in the LAD in patients with fibrosis of RV (n=11) compared to patients without fibrosis (n=9) (p=0.01 and 0.047 respectively). LAD coronary flow was especially increased in patients with RVRP (n=9) as compared with those without (n=11), (p=0.006).
Conclusions:
Patients at mid-term followup after correction of TOF show increase of coronary flow. This increase is more pronounced in patients with fibrosis and RVRP of the RV.
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