Hamaoka K, Onouchi Z, Ohmochi Y, Sakata K
Division of Pediatrics, Children's Research Hospital, Kyoto Prefectural University of Medicine, Japan.
Circulation. 1995 Nov 1;92(9):2457-62. doi: 10.1161/01.cir.92.9.2457.
There have been few reports about coronary hemodynamics in children during the process of growth. In the present study, to assess the characteristics of coronary flow dynamics in children, we examined the phasic coronary flow-velocity (CFV) patterns at rest and during peak hyperemic responses in children with angiographically normal coronary arteries.
Spectral Doppler phasic coronary flow velocity was recorded with a 0.018-in intracoronary Doppler guidewire at rest and during peak responses after intracoronary bolus injection of ATP in 30 patients with Kawasaki's disease (age, 8.2 +/- 5.1 years; 24 boys and 6 girls) without angiographic coronary lesions. Average peak velocity (APV), maximum peak velocity (MPV), and diastolic-to-systolic velocity ratio (DSVR) were evaluated in the left anterior descending coronary artery (LAD), left circumflex artery (LCx), and right coronary artery (RCA). Coronary vasodilator reserve (coronary flow reserve [CFR]) was calculated as the ratio of ATP-induced hyperemic to baseline APV. Flow-velocity parameters in RCA were significantly lower than those in the LAD and LCx in both proximal and distal portions. Although the distal LCx had significantly lower values of APV and MPV than did the proximal LCx, there was no significant difference between the proximal and distal portions of the LAD and RCA for APV and MPV. All three coronary vessels showed a diastolic dominant flow pattern in each segment. This coronary flow pattern was less marked in the RCA than in the LCA. All three coronary vessels showed a significant increase in APV and a significantly decrease in DSVR after ATP administration. CFR was significantly lower in the LCx than in the LAD or RCA (P < .01: 1.93 +/- 0.34 in LCx versus 2.32 +/- 0.42 in LAD and 2.37 +/- 0.44 in RCA). From the view of aging, it was revealed that APV values in three vessels were higher in the younger group than in the older group. CFR values in the LAD and LCx were significantly lower in the younger group than in the older group (P < .001 in LAD: 2.01 +/- 0.28 in the younger versus 2.53 +/- 0.37 in the older; P < .01 in LCx: 1.61 +/- 0.15 in the younger versus 2.06 +/- 0.31 in the older). In addition, intracoronary injection of ATP did not increase the absolute angiographic coronary luminal diameter.
With the use of an intracoronary Doppler guidewire, we demonstrated that there are some characteristic findings in CFV dynamics in childhood. These physiological characteristics in CFV dynamics that occur with aging and occur in each vessel must be taken into consideration in the study of the coronary circulation in children.
关于儿童生长过程中冠状动脉血流动力学的报道较少。在本研究中，为评估儿童冠状动脉血流动力学特征，我们检查了冠状动脉造影正常的儿童在静息状态和充血反应峰值时的冠状动脉血流速度（CFV）相位模式。
使用0.018英寸冠状动脉内多普勒导丝记录30例无冠状动脉造影病变的川崎病患者（年龄8.2±5.1岁；24例男孩和6例女孩）在静息状态和冠状动脉内推注ATP后峰值反应时的频谱多普勒冠状动脉血流速度相位。评估左前降支冠状动脉（LAD）、左旋支动脉（LCx）和右冠状动脉（RCA）的平均峰值速度（APV）、最大峰值速度（MPV）和舒张期与收缩期速度比值（DSVR）。冠状动脉扩张储备（冠状动脉血流储备[CFR]）计算为ATP诱导的充血期与基线APV的比值。RCA近端和远端的血流速度参数均显著低于LAD和LCx。尽管LCx远端的APV和MPV值显著低于近端，但LAD和RCA近端和远端的APV和MPV无显著差异。所有三支冠状动脉在各节段均表现为舒张期占优势的血流模式。这种冠状动脉血流模式在RCA中不如在LCA中明显。所有三支冠状动脉在给予ATP后APV均显著增加，DSVR显著降低。LCx的CFR显著低于LAD或RCA（P<0.01：LCx为1.93±0.34，LAD为2.32±0.42，RCA为2.37±0.44）。从年龄角度来看，发现年轻组三支血管的APV值高于老年组。LAD和LCx的CFR值在年轻组显著低于老年组（LAD中P<0.001：年轻组为2.01±0.28，老年组为2.53±0.37；LCx中P<0.01：年轻组为1.61±0.15，老年组为2.06±0.31）。此外，冠状动脉内注射ATP并未增加冠状动脉造影的绝对管腔直径。
通过使用冠状动脉内多普勒导丝，我们证明儿童CFV动力学存在一些特征性表现。在儿童冠状动脉循环研究中，必须考虑CFV动力学中随年龄变化以及各血管出现的这些生理特征。
