Effects of heart rate and right ventricular pressure on right coronary arterial flow and its systolic versus diastolic distribution in a variety of congenital heart diseases in children

Abstract

We clarify how the RCA manages to increase flow through it at different HR as a function of chronic RVP overload in pediatric cardiac patients.

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

“…RCA flow velocity at rest has been shown to have a positive correlation to systolic right ventricular pressure in children with congenital heart defects in one previous study. 17 Left ventricular hypertrophy and increased left ventricular pressure has similarly been shown to be related to increased diastolic flow velocity at rest and reduced CFR in the LAD in several studies. 18,19 Coronary Vasoreactivity CFR can be measured with PET techniques, cine MR imaging, and Doppler ultrasound.…”

“…18,19 Coronary Vasoreactivity CFR can be measured with PET techniques, cine MR imaging, and Doppler ultrasound. 4,6,17,20 It is well established that the normal adult heart can increase coronary flow/myocardial perfusion maximally by 2.5 to 4 times the resting value, but normal CFR values are different for each method and vasodilator used. 4,10,20,21 Cardiac sympathetic nerves play a part in modulating the function of the coronary arteries.…”

Using Transthoracic Doppler Echocardiography to Diagnose Reduced Coronary Flow Velocity Reserve in the Posterior Descending Coronary Artery in Children With Elevated Right Ventricular Pressure

“…6 Thus, CFVR measurement in the right coronary artery provides useful clinical and physiological information in patients with RV pressure overload; however, it usually requires invasive and expensive techniques with Doppler catheters or positron emission tomography. 5,6 Transthoracic Doppler echocardiography has been proven to reliably assess coronary flow velocity noninvasively. Thus, PD flow velocity measurements by transthoracic Doppler echocardiography may be used in the clinical setting to assess coronary artery function.…”

“…[2][3][4][5][6][7][8] Therefore, an understanding of the coronary circulation under such clinical conditions is important for appropriate long-term hemodynamic management.…”

“…RV pressure overload has been reported to alter RV myocardial oxygen demand and, consequently, coronary flow reserve (CFR). [2][3][4][5][6] The mismatch between myocardial blood supply and ventricular work demand has been proposed as a potential mechanism for RV or left ventricular (LV) dysfunction. 7,8 Therefore, an understanding of the coronary circulation in such clinical conditions is important for appropriate hemodynamic management during long-term follow-up.…”