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J Thorac Cardiovasc Surg 1998;115:103-110
© 1998 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

Resting coronary flow and coronary flow reserve in human infants after repair or palliation of congenital heart defects as measured by positron emission tomography

Department of Pediatrics, Division of Pediatric Cardiology; Department of Surgery, Division of Pediatric Cardiovascular Surgery; and Department of Internal Medicine, Division of Nuclear Medicine; University of Michigan, Ann Arbor, Mich. Supported by funds from the National Institutes of Health through a grant from the Clinical Research Center at the University of Michigan Medical Center.

Received for publication March 25, 1997; revisions requested July 8, 1997; revisions received July 30, 1997; accepted for publication August 8, 1997. Address for reprints: Thomas J. Kulik, MD, University of Michigan Hospitals, MCHC F1310, Box 0204, Ann Arbor, MI 48109–0204.

Objective: Coronary physiology in infants with congenital heart disease remains unclear. Our objective was to better understand coronary physiology in infants with congenital heart disease.
Methods: We used positron emission tomography with nitrogen 13–labeled ammonia to measure myocardial perfusion at rest and with adenosine (142 µg/kg/min x 6 minutes) in five infants after anatomic repair of a congenital heart lesion (group I), and in five infants after Norwood palliation for hypoplastic left heart syndrome (group II). The groups were matched for age, weight, and time from the operation.
Results: Resting coronary flow in the left ventricle in group I was 1.8 ± 0.2 ml/min/gm; resting flow in the right ventricle in group II was 1.0 ± 0.3 ml/min/gm (p = 0.003). Coronary flow with adenosine was 2.6  ± 0.5 ml/min/gm in group I and 1.5 ± 0.7 ml/min/gm in group II (p = 0.02). Absolute coronary flow reserve was the same in both groups (1.5 ± 0.2 in group I vs 1.6 ± 0.3 in group II, p = 0.45). Oxygen delivery was reduced in group II compared with group I at rest (16.1 ± 4.2 ml/min/100 gm vs 28.9 ± 4.42 ml/min/100 gm, p = 0.02) and with adenosine (25.5 ± 8.1 ml/min/100 gm vs 42.3 ± 5.8 ml/min/100 gm, p = 0.02).
Conclusions: Infants with repaired heart disease have higher resting flow and less coronary flow reserve than previously reported for adults. After Norwood palliation, infants have less perfusion and oxygen delivery to the systemic ventricle than do infants with a repaired lesion. This may in part explain why the outcome for patients with Norwood palliation is less favorable than for others. (J Thorac Cardiovasc Surg 1998;115:103-10)

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