Faculty Collaboration Database

The coronary microcirculation in cyanotic congenital heart disease. Circulation 2006 Jul 18;114(3):196-200

Date

07/13/2006

Pubmed ID

16831984

DOI

10.1161/CIRCULATIONAHA.105.602771

Scopus ID

2-s2.0-33747055605 (requires institutional sign-in at Scopus site)   30 Citations

Abstract

BACKGROUND: Despite an appreciable increase in basal coronary blood flow in cyanotic congenital heart disease, flow reserve remains normal. We hypothesized that preservation of flow reserve resides in remodeling of the coronary microcirculation. Microcirculatory morphometric analyses were performed to test this hypothesis.

METHODS AND RESULTS: Necropsy specimens from 4 sources were studied: (1) hearts from patients with Eisenmenger's syndrome (A; n=5), (2) structurally abnormal hearts with ventricular hypertrophy (B; n=8), (3) structurally normal hearts with ventricular hypertrophy (C; n=6), and (4) normal hearts (D; n=5). To compare responses of the microcirculation to hypoxia versus hypertrophy, sections were taken from the left ventricular free wall, which in group A, was hypoxemic but not hypertrophied; in groups B and C, was hypertrophied but not hypoxemic; and in group D, was neither hypertrophied nor hypoxemic. Coronary arterioles were immunolabeled for smooth muscle alpha-actin. Measured morphometric parameters included long and short axes, area, and perimeter. Arteriolar length, volume and surface densities were calculated. There was a significant intergroup difference for arteriolar length density (P=0.03) and diameter (P=0.03). Total length density in group A hearts was markedly lower, but mean arteriolar diameter was significantly greater (34%) compared with group B (P=0.03). Arteriolar volume density was similar to that in the other groups.

CONCLUSIONS: Remodeling of the coronary microcirculation is the key mechanism for preservation of flow reserve in cyanotic congenital heart disease. The increase in short axis (diameter) compensated for lower arteriolar length density and was the principal anatomic basis for maintenance of normal flow reserve.

Author List

Dedkov EI, Perloff JK, Tomanek RJ, Fishbein MC, Gutterman DD

MESH terms used to index this publication - Major topics in bold

Adult
Blood Flow Velocity
Cardiomyopathies
Coronary Circulation
Coronary Vessels
Cyanosis
Eisenmenger Complex
Heart Defects, Congenital
Humans
Medical Records
Microcirculation
Models, Anatomic
Retrospective Studies