title: Abnormal vasomotor function of the epicardial coronary arteries in children five to eight years after arterial switch operation: an angiographic and intracoronary Doppler flow wire study.
abstract: OBJECTIVE
  This study sought to test the vasoreactivity of the translocated coronary arteries after arterial switch operation (ASO) using quantitative angiographic analysis and intracoronary Doppler flow wire velocimetry.
  
  
  BACKGROUND
  Late coronary artery events occur in 3% to 8% of patients after the ASO. Previous studies of coronary flow reserve have yielded disparate results.
  
  
  METHODS
  Nineteen children previously underwent ASO (13 boys, age 5.4 +/- 3.2 years, weight 22.3 +/- 10.6 kg), and six control patients were enrolled in the study. Each patient underwent quantitative angiographic assessment of the epicardial coronary arteries before and after administration of nitroglycerin and coronary blood flow volume assessment before and after administration of adenosine and acetylcholine. The results were compared between groups.
  
  
  RESULTS
  Epicardial coronary artery dilation in response to intracoronary nitroglycerin was significantly less in the ASO group than in the control group (left anterior descending [LAD], 5.0 +/- 0.05% vs. 18.0 +/- 4.5%, p = 0.0009; right coronary artery [RCA], 4.0 +/- 0.07% vs. 32.7 +/- 12.7%, p = 0.006). Moreover, the coronary blood flow volume reserve was reduced in ASO patients compared with control patients after intracoronary infusion of acetylcholine (2.3 +/- 0.9 vs. 4.9 +/- 1.7, p = 0.0003) or adenosine (2.7 +/- 1.5 vs. 5 +/- 0.5, p = 0.002).
  
  
  CONCLUSIONS
  Epicardial coronary arteries fail to dilate normally in children after ASO, and the calculated coronary flow volume reserve is consequently reduced.
authors.affiliation: Dipartimento Medico-Chirurgico di Cardiologia Pediatrica, Ospedale Bambino Gesù, Rome, Italy. gagliard@opbg.net
authors.forename: Maria Giulia
authors.initials: MG
authors.lastname: Gagliardi
authors.forename: Rachele
authors.initials: R
authors.lastname: Adorisio
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
authors.forename: Paolo
authors.initials: P
authors.lastname: Versacci
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Donato
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Sanders
mesh_terms: D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D014188:Transposition of Great Vessels / Q000503:physiopathology* / Q000601:surgery*; D018608:Ultrasonography, Doppler; D014666:Vasomotor System / Q000000981:diagnostic imaging / Q000503:physiopathology*