Harada Kenja, Aoki Mieko, Toyono Manatomo, Tamura Masamichi
Department of Pediatrics, Akita University School of Medicine, Akita 010-8543, Japan.
Tohoku J Exp Med. 2004 Feb;202(2):77-85. doi: 10.1620/tjem.202.77.
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 < .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.
为评估左心室（LV）容量超负荷的先天性心脏病患者的冠状动脉血流特征，我们对24例室间隔缺损患儿（平均12.1±7.1个月）进行了检查。肺循环与体循环血流量之比为1.1至3.0。对照组由10例年龄匹配的儿童组成，他们在急性期患有川崎病且冠状动脉造影正常。通过左心室造影测量左心室舒张末期容积和左心室质量。使用多普勒血流导丝（0.014英寸），记录左前降支冠状动脉在静息和充血状态下（静脉注射腺苷0.16mg/kg/min）的平均峰值流速（APV）。冠状动脉血流速度储备（CFVR）计算为充血期/静息期APV的比值。7例患者在术后5至7个月也接受了研究。与对照组相比，LV容量超负荷患者的CFVR显著降低（1.78±0.24对2.66±0.42，p<0.0001），因为静息期APV显著更高（30±8对23±5cm/秒，p=0.0027）。观察到CFVR与Qp/Qs、静息期APV、左心室舒张末期容积或左心室质量之间存在显著相关性。逐步回归分析表明，静息期APV和Qp/Qs是CFVR的重要决定因素（CFVR=2.64 - 0.202[Qp/Qs] - 0.015[APV]，r = 0.83，p<0.0001）。在7例LV容量超负荷患者中，术后CFVR显著改善，原因是静息期APV降低。由于静息期基础APV升高，LV容量超负荷患者的CFVR受限。左前降支血流模式取决于LV容量超负荷水平及其术后变化。
