Submitted on January 8, 2007
Accepted on April 27, 2007
Effects of cardio-pulmonary bypass surgery on coronary flow in children assessed with transthoracic Doppler echocardiography
Elhadi H. Aburawi1*, Ansgar Berg2, Petru Liuba1, and Erkki Pesonen1
1 Pediatric Cardiology, Lund University Hospital, Lund, Skane, Sweden
2 Pediatrics, Haukeland University, Bergen, Norway
* To whom correspondence should be addressed. E-mail: elhadi.aburawi{at}med.lu.se.
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 (TTDE). 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 months while off-pump surgery (aortic coarctectomy) was undertaken at the mean age of 10 days in twelve children. After CPB surgery, both LAD`s mean diameter and basal CF increased from 1.7±0.3 to 2.1±0.4 mm (p=0.001) and 27±8 to 63±18 ml/minute (p=0.0001), respectively. These two coronary variables decreased after off-pump coarctectomy: LAD's mean diameter from 1.8 ± 0.1 to 1.7 ± 0.1 mm (p=0.06), and CF from 44 ± 20 to 22 ± 14 ml/minute (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 post surgical decline in flow in these patients seems to relate to the reduction in cardiac pressure afterload.
