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Abnormal myocardial blood flow in children with mild/moderate aortic stenosis

Erin Madriago1, Ronald Wells1, David J Sahn1

  • 11Doernbecher Children's Hospital,Oregon Health & Science University,Portland,Oregon,United States of America.

Cardiology in the Young
|February 11, 2015
PubMed

Insights

Children with mild/moderate aortic stenosis show abnormal myocardial blood flow. This finding suggests that myocardial blood flow abnormalities in pediatric aortic stenosis may be a key therapeutic target.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Cardiovascular Imaging

Background:

  • Asymptomatic children with mild/moderate aortic stenosis may have underlying myocardial abnormalities.
  • Normative myocardial blood flow (MBF) data in pediatric populations using cardiac magnetic resonance (CMR) is lacking.
  • Aortic stenosis (AS) can affect myocardial function and perfusion.

Purpose of the Study:

  • To quantify myocardial blood flow (MBF) in infants and children with mild or moderate aortic stenosis (AS).
  • To establish normative MBF data in a pediatric cohort using adenosine-infusion CMR.
  • To investigate potential myocardial abnormalities in pediatric AS.

Main Methods:

  • Adenosine-infusion cardiac magnetic resonance (CMR) was performed on 31 infants and children (11 with mild/moderate AS, 20 controls).
  • Myocardial blood flow was quantified using deconvolution analysis of contrast agent uptake in the left ventricular myocardium.
  • Measurements were taken at rest and during hyperemia induced by adenosine infusion.

Main Results:

  • Adenosine infusion was well-tolerated in all participants.
  • Children with mild/moderate AS exhibited higher left ventricular-to-aorta pressure gradients and slightly increased left ventricular wall mass compared to controls.
  • Myocardial blood flow, both absolute increase and hyperemic response, was significantly reduced in children with AS compared to controls (p<0.0001).

Conclusions:

  • Children with mild/moderate aortic stenosis demonstrate abnormal myocardial blood flow.
  • Reduced myocardial blood flow in pediatric AS suggests potential myocardial dysfunction.
  • Abnormal MBF in pediatric AS may represent a critical therapeutic target for intervention.
Abstract

Keywords:
Congenital heart diseaseaortic stenosiscontrast mediafibrosisperfusion

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