Site of coronary sinus drainage does not significantly affect coronary flow reserve in patients long term after Fontan operation.
This study was designed to investigate the impact of postoperative coronary sinus drainage pressure on coronary flow reserve (CFR) assessed by Doppler guidewire in patients long term after Fontan operation. Twenty-nine patients (median age, 17.4 years female, 11) at a median of 10.6 years after Fontan operation were examined with intracoronary Doppler guidewire during cardiac catheterization. Fourteen patients had coronary sinus (CS) drainage to the systemic venous atrium and 15 patients had CS drainage to the pulmonary venous atrium after Fontan operation. Median CS drainage pressure was significantly higher in systemic venous CS drainage compared to pulmonary venous CS drainage (11 vs 5 mmHg, p < 0.0001). Median CFR values for the right and left coronary artery did not differ significantly with respect to CS drainage. There was a positive correlation between coronary flow reserve and pulmonary arteriolar resistance (p < 0.05) in multivariate regression analysis. The site of coronary drainage into the systemic atrium or the pulmonary venous atrium did not significantly affect CFR. Our data do not support a surgical strategy of elective redirection of coronary sinus blood to a low-pressure compartment but support an early staged approach. The positive correlation between CFR and pulmonary resistance demands further evaluation.
Eicken
A
A
Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum, München, Technische Universität München, Lazarettstrasse 36, D-80636, Munich, Germany. eicken@dhm.mhn.de.
Sebening
W
W
Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum, München, Technische Universität München, Lazarettstrasse 36, D-80636, Munich, Germany.
Genz
T
T
Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum, München, Technische Universität München, Lazarettstrasse 36, D-80636, Munich, Germany.
Kaemmerer
H
H
Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum, München, Technische Universität München, Lazarettstrasse 36, D-80636, Munich, Germany.
Lange
R
R
Department of Thoracic and Cardiovascular Surgery, Deutsches Herzzentrum, München, Technische Universität München, Lazarettstrasse 36, D-80636, Munich, Germany.
Busch
R
R
Institute of Medical Statistics and Epidemiology, Technische Universität München, Lazarettstrasse 36, D-80636, Munich, Germany.
Hess
J
J
Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum, München, Technische Universität München, Lazarettstrasse 36, D-80636, Munich, Germany.
D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology*; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D003326:Coronary Circulation / Q000502:physiology*; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011652:Pulmonary Circulation / Q000502:physiology; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000503:physiopathology; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012044:Regression Analysis; D013223:Statistics as Topic; D014655:Vascular Resistance / Q000502:physiology*; D014690:Venous Pressure / Q000502:physiology