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Abnormal myocardial blood flow in children with mild/moderate aortic stenosis

Published online by Cambridge University Press:  10 February 2015

Erin Madriago ,
Ronald Wells ,
David J. Sahn ,
Brian S. Diggs ,
Stephen M. Langley ,
Daniel J. Woodward ,
Michael Jerosch-Herold  and
Michael Silberbach
Erin Madriago
Affiliation:
Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, Oregon, United States of America
Ronald Wells
Affiliation:
Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, Oregon, United States of America
David J. Sahn
Affiliation:
Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, Oregon, United States of America
Brian S. Diggs
Affiliation:
Department of Surgery, Oregon Health & Science University, Portland, Oregon, United States of America
Stephen M. Langley
Affiliation:
Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, Oregon, United States of America Department of Surgery, Oregon Health & Science University, Portland, Oregon, United States of America
Daniel J. Woodward
Affiliation:
Department of Anesthesiology, Oregon Health & Science University, Portland, Oregon, United States of America
Michael Jerosch-Herold
Affiliation:
Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
Michael Silberbach*
Affiliation:
Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, Oregon, United States of America
*
Correspondence to: Dr Michael Silberbach, MD, Division of Pediatric Cardiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America. Tel: +(503) 494-2192; Fax +(503) 418-5793; E-mail: [email protected]
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Abstract

Objective

To quantify myocardial blood flow in infants and children with mild or moderate aortic stenosis using adenosine-infusion cardiac magnetic resonance.

Background

It is unclear whether asymptomatic children with mild/moderate aortic stenosis have myocardial abnormalities. In addition, cardiac magnetic resonance-determined normative myocardial blood flow data in children have not been reported.

Methods

We studied 31 infants and children with either haemodynamically normal hearts (n=20, controls) or mild/moderate aortic stenosis (n=11). The left ventricular myocardium was divided into six segments, and the change in average segmental signal intensity during contrast transit was used to quantify absolute flow (ml/g/minute) at rest and during adenosine infusion by deconvolution of the tissue curves with the arterial input of contrast.

Results

In all the cases, adenosine was well tolerated without complications. The mean pressure gradient between the left ventricle and the ascending aorta was higher in the aortic stenosis group compared with controls (24 versus 3 mmHg, p<0.001). Left ventricular wall mass was slightly higher in the aortic stenosis group compared with controls (65 versus 50 g/m2, p<0.05). After adenosine treatment, both the absolute increase in myocardial blood flow (p<0.0001) and the hyperaemic flow significantly decreased (p<0.001) in children with mild/moderate aortic stenosis compared with controls.

Conclusion

Abnormal myocardial blood flow in children with mild/moderate aortic stenosis may be an important therapeutic target.

Keywords

Congenital heart diseaseaortic stenosisperfusionfibrosiscontrast media
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 7 , October 2015 , pp. 1358 - 1366
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Copyright
© Cambridge University Press 2015 

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