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Assessment of Coronary Flow Reserve in the Coronary Sinus by Cine 3T-Magnetic Resonance Imaging in Young Adults after Surgery for Tetralogy of Fallot

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Abstract

This study aimed to evaluate CFR by assessing blood flow in the coronary sinus and systemic endothelial function measured by FMD of the brachial artery in an open prospective study of 10 control subjects and 10 patients (ages, 15–25 years) who have undergone surgical TOF repair. Reduced ventricular function, impaired exercise capacity, and ventricular arrhythmia have been proposed as risk factors for sudden cardiac death after surgical repair of TOF. Some of this may be related to impaired myocardial perfusion. A 3.0T GE Signa Excite scanner was used to achieve phase-contrast, velocity-encoding cine magnetic resonance imaging in the coronary sinus before and during infusion with adenosine (0.14 mg/kg/min). FMD was measured in the brachial artery before arterial occlusion and 5 min afterward. The TOF group demonstrated significantly higher volumetric blood flow in the coronary sinus (282 ± 63 ml/min) than the normal control subjects at rest (184 ± 57 ml/min) (P = 0.006). During adenosine infusion, this difference disappeared. The CFR was 2.00 ± 0.43 in the control group and 1.19 ± 0.34 in the TOF group (P = 0.002). No correlation between FMD and CFR was observed in the study group (r s = 0.61, n = 8, P = 0.15). This study showed a reduced CFR due to a higher blood flow of the subject at rest in the TOF group. This reduced CFR may disable a normal adaptation to increased oxygen demand during exercise and increase myocardial vulnerability to reduced blood supply postoperatively for TOF patients with coronary heart disease.

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Acknowledgments

We thank Merethe Lemme and Christel Jansen for their excellent contribution to the MRI scanning. This project was supported by grants from the University of Bergen, Grieg Foundation, and Tordis and Fritz C. Riebers’ Foundation.

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Authors and Affiliations

  1. Department of Clinical Medicine, University of Bergen, 5021, Bergen, Norway

    Jochem Cuypers, Ansgar Berg & Gottfried Greve

  2. Department of Heart Disease, Haukeland University Hospital, Bergen, Norway

    Elisabeth Leirgul, Terje H. Larsen, Ansgar Berg & Gottfried Greve

  3. Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway

    Stig Samnøy

  4. Department of Biomedicine, University of Bergen, Bergen, Norway

    Terje H. Larsen

  5. Department of Pediatrics, Haukeland University Hospital, Bergen, Norway

    Ansgar Berg

  6. Institute for Child Health, Great Ormond Street Hospital for Sick Children, London, UK

    Ingram Schulze-Neick

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  1. Jochem Cuypers
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Correspondence to Jochem Cuypers.

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Cuypers, J., Leirgul, E., Samnøy, S. et al. Assessment of Coronary Flow Reserve in the Coronary Sinus by Cine 3T-Magnetic Resonance Imaging in Young Adults after Surgery for Tetralogy of Fallot. Pediatr Cardiol 33, 65–74 (2012). https://doi.org/10.1007/s00246-011-0091-9

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