Effects of cardiopulmonary bypass surgery on coronary flow in children assessed with transthoracic Doppler echocardiography.
Perturbation of coronary blood flow (CF) is an important contributor to myocardium-related complications. The study was primarily designed to assess the impact of cardiopulmonary bypass (CPB) surgery on CF by aid of transthoracic Doppler echocardiography. Changes in CF after off-pump coarctation surgery were also studied. All ultrasounds were performed before and 5 +/- 1 days after surgery. Eighteen children underwent CPB surgery of ventricular left-to-right shunts at the mean age of 6 mo, while off-pump surgery (aortic coarctectomy) was undertaken at the mean age of 10 days in 12 children. After CPB surgery, both left anterior descending coronary artery mean diameter and basal CF increased from 1.7 +/- 0.3 to 2.1 +/- 0.4 mm (P = 0.001) and 27 +/- 10 to 47 +/- 15 ml/min (P = 0.0001), respectively. These two coronary variables decreased after off-pump coarctectomy: left anterior descending coronary artery mean diameter from 1.8 +/- 0.1 to 1.7 +/- 0.1 mm (P = 0.06), and CF from 44 +/- 12 to 25 +/- 8 ml/min (P = 0.001). The findings are in keeping with the hypothesis that the previously reported impairment of coronary flow reserve after CPB surgery could be due to increase in basal coronary flow after CPB. Off-pump coarctectomy seems to have little impact on CF, as the postsurgical decline in flow in these patients seems to relate to the reduction in cardiac pressure afterload.
Aburawi
Elhadi H
EH
Division of Pediatric Cardiology/Department of Pediatrics, Lund University Hospital, Getingvägen, SE-221 85 Lund, Sweden. elhadi.aburawi@med.lu.se
Berg
Ansgar
A
Liuba
Petru
P
Pesonen
Erkki
E
D001017:Aortic Coarctation / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D016022:Case-Control Studies; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D015150:Echocardiography, Doppler; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015588:Observer Variation; D015203:Reproducibility of Results; D012107:Research Design; D016896:Treatment Outcome; D016277:Ventricular Function, Left