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Coronary flow reserve in the newborn lamb: An intracoronary Doppler guide wire study

Oskarsson, Gylfi; Pesonen, Erkki LU ; Gudmundsson, Saemundur LU ; Ingimarsson, Jonas LU ; Sandström, Staffan LU and Werner, Olof LU (2004) In Pediatric Research 55(2). p.205-210
Abstract
Recent studies indicate a severely reduced coronary flow reserve (CFR) in neonates with congenital heart disease. The significance of these studies remains debatable, as the ability of the anatomically normal neonatal heart to increase coronary flow is currently unknown. This study was designed to establish normal values for CFR in newborns after administration of adenosine [pharmacologic CFR (pCFR)] and as induced by acute hypoxemia (reactive CFR). Thirteen mechanically ventilated newborn lambs were studied. Coronary flow velocities were measured in the proximal left anterior descending coronary artery before and after adenosine injection (140 and 280 mug/kg i.v.) using an intracoronary 0.014-in Doppler flow-wire. Measurements were made... (More)
Recent studies indicate a severely reduced coronary flow reserve (CFR) in neonates with congenital heart disease. The significance of these studies remains debatable, as the ability of the anatomically normal neonatal heart to increase coronary flow is currently unknown. This study was designed to establish normal values for CFR in newborns after administration of adenosine [pharmacologic CFR (pCFR)] and as induced by acute hypoxemia (reactive CFR). Thirteen mechanically ventilated newborn lambs were studied. Coronary flow velocities were measured in the proximal left anterior descending coronary artery before and after adenosine injection (140 and 280 mug/kg i.v.) using an intracoronary 0.014-in Doppler flow-wire. Measurements were made at normal oxygen saturation (Sao(2)) and during progressive hypoxemia induced by lowering the fraction of inspired oxygen. CFR was defined as the ratio of hyperemic to basal average peak flow velocity. In a hemodynamically stable situation with normal Sao(2,) pCFR was 3.0 +/- 0.5. pCFR decreased with increasing hypoxemia. Regression analysis showed a linear relation between Sao(2) and pCFR (R = 0.86, p < 0.0001). Reactive CFR obtained at severe hypoxemia (Sao(2) <30%) was 4.2 +/- 0.8, and no significant further increase in coronary flow velocity occurred by administration of adenosine. Newborn lambs have a similar capacity to increase coronary flow in response to both pharmacologic and reactive stimuli as older subjects. Administration of adenosine does not reveal the full capacity of the newborn coronary circulation to increase flow, however, as the flow increase caused by severe hypoxemia is significantly more pronounced. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Pediatric Research
volume
55
issue
2
pages
205 - 210
publisher
International Pediatric Foundation Inc.
external identifiers
  • pmid:14630989
  • wos:000188465100005
  • scopus:1642474325
ISSN
1530-0447
DOI
10.1203/01.PDR.0000103932.09752.D6
language
English
LU publication?
yes
id
2286a0f7-5934-41f8-aed8-94b7a8b75a40 (old id 288950)
alternative location
http://www.pedresearch.org/pt/re/pedresearch/abstract.00006450-200402000-00006.htm
date added to LUP
2007-10-29 12:17:26
date last changed
2017-01-01 05:16:50
@article{2286a0f7-5934-41f8-aed8-94b7a8b75a40,
  abstract     = {Recent studies indicate a severely reduced coronary flow reserve (CFR) in neonates with congenital heart disease. The significance of these studies remains debatable, as the ability of the anatomically normal neonatal heart to increase coronary flow is currently unknown. This study was designed to establish normal values for CFR in newborns after administration of adenosine [pharmacologic CFR (pCFR)] and as induced by acute hypoxemia (reactive CFR). Thirteen mechanically ventilated newborn lambs were studied. Coronary flow velocities were measured in the proximal left anterior descending coronary artery before and after adenosine injection (140 and 280 mug/kg i.v.) using an intracoronary 0.014-in Doppler flow-wire. Measurements were made at normal oxygen saturation (Sao(2)) and during progressive hypoxemia induced by lowering the fraction of inspired oxygen. CFR was defined as the ratio of hyperemic to basal average peak flow velocity. In a hemodynamically stable situation with normal Sao(2,) pCFR was 3.0 +/- 0.5. pCFR decreased with increasing hypoxemia. Regression analysis showed a linear relation between Sao(2) and pCFR (R = 0.86, p &lt; 0.0001). Reactive CFR obtained at severe hypoxemia (Sao(2) &lt;30%) was 4.2 +/- 0.8, and no significant further increase in coronary flow velocity occurred by administration of adenosine. Newborn lambs have a similar capacity to increase coronary flow in response to both pharmacologic and reactive stimuli as older subjects. Administration of adenosine does not reveal the full capacity of the newborn coronary circulation to increase flow, however, as the flow increase caused by severe hypoxemia is significantly more pronounced.},
  author       = {Oskarsson, Gylfi and Pesonen, Erkki and Gudmundsson, Saemundur and Ingimarsson, Jonas and Sandström, Staffan and Werner, Olof},
  issn         = {1530-0447},
  language     = {eng},
  number       = {2},
  pages        = {205--210},
  publisher    = {International Pediatric Foundation Inc.},
  series       = {Pediatric Research},
  title        = {Coronary flow reserve in the newborn lamb: An intracoronary Doppler guide wire study},
  url          = {http://dx.doi.org/10.1203/01.PDR.0000103932.09752.D6},
  volume       = {55},
  year         = {2004},
}