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.
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Article info
Publication history
Accepted:
March 15,
2010
Received in revised form:
March 15,
2010
Received:
February 3,
2010
Footnotes
This work was supported by a grant to Dr. Singh from the Children's Heart Foundation, Lincolnshire, Illinois.
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
