Resting coronary flow and coronary flow reserve in human infants after repair or palliation of congenital heart defects as measured by positron emission tomography

Abstract

Infants with repaired heart disease have higher resting flow and less coronary flow reserve than previously reported for adults. After Norwood palliation, infants have less perfusion and oxygen delivery to the systemic ventricle than do infants with a repaired lesion. This may in part explain why the outcome for patients with Norwood palliation is less favorable than for others.

Risk Factors for Death or Heart Transplant for Patients with Right Ventricular Dysfunction After the Norwood Procedure: A Secondary Analysis of the Single Ventricle Reconstruction Trial

“…In addition, the demonstration of the cumulative effect of the other risk factors on transplant-free survival in addition to shunt (Figure 30) suggests that the physiology of patients with a BT shunt and RVPA conduit is fragile. The hypothesis that poor coronary perfusion associated with the diastolic run off caused by a BT shunt which leads to a poor myocardia perfusion ( Figure 34) (Bradley et al 2004;Ghanayem et al 2006;Donnelly et al 1998;DeCampli et al 2013;Hsia et al 2011), is …”

“…A diastolic run off means that flow to the pulmonary arteries continues in diastole instead of only occurring in systole ( figure 34 and 35). This diastolic run off in turn reduces the diastolic pressure within the aorta (Bradley et al 2004;Ghanayem et al 2006;Donnelly et al 1998;DeCampli et al 2013). Coronary artery flow mainly occurs during diastole and is dependent on the aortic diastolic pressure as well as the pressure difference between aorta and the left ventricle (Driscol et al 1964).…”

“…Coronary artery flow mainly occurs during diastole and is dependent on the aortic diastolic pressure as well as the pressure difference between aorta and the left ventricle (Driscol et al 1964). The BT shunt can lead to lower coronary artery perfusion, which in turn can lead to myocardial ischemia (Donnelly et al 1998) (Figure 34). This phenomenon could cause ventricular dysfunction secondary to myocardial cell death from ischemia.…”

Normal Coronary Flow Reserve After Arterial Switch Operation for Transposition of the Great Arteries

“…Neonates operated for a ventricular septal defect, with entirely normal postoperative hemodynamics, had low CFR (1.5 to 1.6), according to a PET study performed Ϸ2 weeks after surgery. 29 Studies measuring global myocardial CFR with the PET method in patients operated with open-heart surgery in the neonatal period have shown low CFR values, irrespective of the type of heart malformation or type of surgery. 4,5,29 CFR in these studies has tended to be higher the older the subjects are at the time of examination.…”

“…29 Studies measuring global myocardial CFR with the PET method in patients operated with open-heart surgery in the neonatal period have shown low CFR values, irrespective of the type of heart malformation or type of surgery. 4,5,29 CFR in these studies has tended to be higher the older the subjects are at the time of examination. This opinion is further supported by the observation that children operated at an older age with reimplantation of the coronary arteries (Ross operation) have normal CFR, according to PET.…”