Myocardial flow reserve in patients with a systemic right ventricle after atrial switch repair

Singh, Tajinder P.; Humes, Richard A.; Muzik, Otto; Kottamasu, Sambasiva R.; Karpawich, Peter P.; Carli, Marcelo F. Di

doi:10.1016/s0735-1097(01)01283-9

Cited by 80 publications

(48 citation statements)

References 23 publications

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“…Hyperemic myocardial blood flow to the systolic RV has been shown to be 38% lower in Mustard patients than in controls. 17 Studies of systemic RV patients suggest an abnormal response to dobutamine stress with the use of both echocardiography and CMR 18 -20 and impaired response to exercise, which may support the hypothesis that poor myocardial flow reserve may contribute to the dysfunction observed.…”

Section: Pathophysiological Mechanisms Of Late Rv Failurementioning

confidence: 82%

Late Gadolinium Enhancement Cardiovascular Magnetic Resonance of the Systemic Right Ventricle in Adults With Previous Atrial Redirection Surgery for Transposition of the Great Arteries

et al. 2005

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Background-Patients treated for transposition of the great arteries by atrial redirection surgery have a right ventricle (RV) that sustains systemic pressures long term. Late RV dysfunction occurs in these patients; the reasons for this are unclear, but myocardial fibrosis may be important. Myocardial fibrosis can be visualized by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR). We hypothesized that LGE would be present in the systemic RV and relate to adverse clinical features. Methods and Results-We performed CMR on 36 consecutive adult patients (mean age, 27 years) after atrial redirection surgery for transposition of the great arteries. Late gadolinium RV enhancement was seen in 22 patients (61%) with various patterns. Patients with RV LGE were older (30 versus 22 years; PϽ0.001) and had increased RV end-systolic volume index (43 versus 35 mL/m 2 ; Pϭ0.03), decreased RV ejection fraction (57% versus 62%; Pϭ0.02), increased QRS duration (108 versus 97 ms; Pϭ0.01), and increased QT dispersion (93 versus 71 ms; Pϭ0.002). The extent of LGE correlated with age (rϭ0.59, PϽ0.001) and QRS duration (rϭ0.67, PϽ0.001) and inversely with RV ejection fraction (rϭϪ0.76, PϽ0.001). The incidence of documented arrhythmia and/or syncope (10 of 36) was significantly higher in the late gadolinium-positive group (9/22 versus 1/14; Pϭ0.03). Key Words: heart ventricles Ⅲ magnetic resonance imaging Ⅲ heart defects, congenital Ⅲ transposition of great vessels Ⅲ fibrosis B efore use of the arterial switch operation, patients with transposition of the great arteries were palliated by redirection of blood at the atrial level with the Senning 1 or Mustard operation. 2 There is a contemporary adult population in whom the right ventricle (RV) must sustain systemic pressure long term. Late RV dysfunction is common in these patients 3 and may be related to myocardial fibrosis. In patients with a systemic left ventricle (LV), cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) can detect myocardial fibrosis in both ischemic and nonischemic cardiomyopathies. 4,5 We hypothesized that LGE would be present in the systemic RV and that it would be associated with markers of adverse clinical outcome. 4 Conclusions-LGE Methods Patient PopulationConsecutive patients with transposition of the great arteries who had undergone either the Mustard or Senning procedure were invited to participate. Patients with a permanent pacemaker in situ were excluded. The local research ethics committee approved the study, and all patients gave written informed consent. Cardiovascular Magnetic ResonanceA 1.5-T scanner was used (Siemens Sonata). After routine assessment of anatomy, the patency of atrial pathways and function of valves were assessed by steady-state free precession (SSFP) cine imaging in a sequence of specified oblique planes. They were aligned with each atrial pathway, the inflow valves in long-axis planes, and the outflow tracts. Peak velocity was measured at the narrowest point of each caval pathwa...

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Section: Pathophysiological Mechanisms Of Late Rv Failurementioning

confidence: 82%

Late Gadolinium Enhancement Cardiovascular Magnetic Resonance of the Systemic Right Ventricle in Adults With Previous Atrial Redirection Surgery for Transposition of the Great Arteries

et al. 2005

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“…Coronary flow velocity and coronary flow velocity reserve (CFVR) measurements have provided useful clinical and physiologic information in pediatric patients with congenital or acquired hear disease (Doty et al 1984;Hamaoka et al 1992Hamaoka et al ,1998Hijazi et al 1994;Bengel et al 1998;Donnelly et al 1998;Pitkanen et al 1998;Yates et al 2000;Hauser et al 2001;Singth et al 2001;Oskarson et al 2002;Yasuoka et al 2002;Aoki et al 2003). Recently, Doppler-tipped angioplastic 0.018-or 0.014-inch Doppler guide wire has been developed to measure coronary blood flow velocity even in children.…”

mentioning

confidence: 99%

Coronary Flow Velocity and Coronary Flow Velocity Reserve in Children with Ventricular Septal Defect

Harada

Aoki

Toyono

et al. 2004

Tohoku J. Exp. Med.

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HARADA, K., AOKI, M., TOYONO, M. and TAMURA, M. Coronary Flow Velocity and Coronary Flow Velocity Reserve in Children with Ventricular Septal Defect. Tohoku J. Exp. Med., 2004, 202 (2), 77-85 To assess coronary flow characteristics in congenital heart defect with left ventricular (LV) volume overload, we examined 24 children (mean 12.1±7.1 months) with ventricular septal defect. The pulmonary to systemic flow ratio ranged from 1.1 to 3.0. Control group consisted of 10 age-matched children who had a history of Kawasaki disease with angiographically normal coronary artery in the acute phase. LV end-diastolic volume and LV mass were measured by left ventriculogram. With Doppler flow guide wire (0.014-inch), average peak flow velocity (APV) in left anterior descending coronary artery was recorded at rest and during hyperemia (0.16 mg/kg/min adenosine infusion intravenously). Coronary flow velocity reserve (CFVR) was calculated as the ratio of hyperemic/baseline APV. Seven patients were also studied 5-7 months after surgery. Compared with control subjects, CFVR was significantly reduced in patients with LVvolume overload (1.78±0.24 vs. 2.66±0.42, p<0.0001) because baseline APV was significantly greater (30±8 vs. 23±5 cm/sec, p=0.0027). Significant correlations were observed between CFVR and Qp/Qs, baseline APV, LV end-diastolic volume, or LVmass. Stepwise regression analysis showed that baseline APV and Qp/Qs were important determinants of CFVR (CFVR=2.64−0.202 [Qp/Qs]−0.015 [APV] r=0.83, p<0.0001). In 7 patients with LVvolume overload, CFVR improved significantly after surgery because of reduction of baseline APV. CFVR is limited in patients with LV volume overload because of the elevation of baseline resting APV. LAD flow pattern is dependent on LV volume overload level and its changes after surgery. ventricular septal defect; coronary flow velocity reserve

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“…[21][22][23][24] CFVR has been reported as impaired in patients after atrial switch repair, suggesting RV dysfunction in long-term survivors of the Mustard operation. 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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

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

Shimada

Harada

Toyono

et al. 2007

Circ J

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Myocardial flow reserve in patients with a systemic right ventricle after atrial switch repair

Abstract: Myocardial flow reserve is impaired in systemic RVs in survivors of the Mustard operation. This may contribute to systemic ventricular dysfunction in these patients.

Cited by 80 publications

References 23 publications

Late Gadolinium Enhancement Cardiovascular Magnetic Resonance of the Systemic Right Ventricle in Adults With Previous Atrial Redirection Surgery for Transposition of the Great Arteries

Late Gadolinium Enhancement Cardiovascular Magnetic Resonance of the Systemic Right Ventricle in Adults With Previous Atrial Redirection Surgery for Transposition of the Great Arteries

Coronary Flow Velocity and Coronary Flow Velocity Reserve in Children with Ventricular Septal Defect

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

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