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A study of the physiological consequences of sympathetic denervation of the heart caused by the arterial switch procedure

Published online by Cambridge University Press:  11 March 2010

Cecilia Falkenberg ,
Stefan Hallhagen ,
Krister Nilsson ,
Boris Nilsson  and
Ingegerd Östman-Smith
Cecilia Falkenberg
Affiliation:
Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, Queen Silvia Children’s Hospital, Gothenburg, Sweden
Stefan Hallhagen
Affiliation:
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital/Queen Silvia Children’s Hospital, Gothenburg, Sweden
Krister Nilsson
Affiliation:
Department of Anaesthetics, Institute of Clinical Sciences, The Sahlgrenska Academy, Queen Silvia Children’s Hospital, Gothenburg, Sweden
Boris Nilsson
Affiliation:
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital/Queen Silvia Children’s Hospital, Gothenburg, Sweden
Ingegerd Östman-Smith*
Affiliation:
Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, Queen Silvia Children’s Hospital, Gothenburg, Sweden
*
Correspondence to: Professor Ingegerd Östman-Smith, Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, Queen Silvia Children’s Hospital, Gothenburg University, SE-416 85, Gothenburg, Sweden. Tel: +46 31 3434512; Fax: +46 31 3435947; E-mail: ingegerd.ostman-smith@pediat.gu.se
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Abstract

Background

The arterial switch operation is the corrective operation for transposition of the great arteries, defined as the combination of concordant atrioventricular and discordant ventriculo–arterial connections, but there have been concerns about silent subendocardial ischaemia on exercise and coronary artery growth. The arterial switch divides the majority of the sympathetic nerves entering the heart; we have studied the effects of coronary flow and sensitivity to catecholamine stimulation in an animal model.

Methods

A total of 10 piglets were operated on cardiopulmonary bypass with section and resuturing of aortic trunk, pulmonary artery and both coronary arteries, with 13 sham-operated controls. After 5–7 weeks of recovery, seven simulated switch survivors and 13 controls were studied.

Results

Basal heart rate was significantly higher in switch piglets: in vivo mean (standard deviation) 112 (12) versus sham 100 (10) beats per minute, (p = 0.042); in vitro (Langendorff preparation): 89 (9) versus sham 73 (8) beats per minute (p = 0.0056). In vivo maximal heart rate in response to epinephrine was increased in switch piglets, 209 (13) versus 190 (17) beats per minute (p = 0.044). In vitro dose–response curves to norepinephrine were shifted leftward and upwards (p = 0.0014), with an 80% increase in heart rate induced by 0.095 (0.053) norepinephrine micromole per litre perfusate in switch hearts versus 0.180 (0.035) norepinephrine micromole per litre (p = 0.023). Increase in coronary flow on norepinephrine stimulation and maximal coronary flow were significantly reduced in switch hearts: 0.3 (0.2) versus 0.8 (0.4) millilitre per gram heart weight (p = 0.045) and 2.5 (0.4) versus 3.1 (0.4) millilitre per gram heart (p = 0.030), respectively.

Conclusions

A combination of increased intrinsic heart rate, increased sensitivity to chronotropic actions of norepinephrine, and a decreased maximal coronary flow creates potential for a mismatch between perfusion and energy demands.

Keywords

Congenital heart diseasecoronary artery flowsympathectomysupersensitivitynorepinephrineepinephrine
Type
Original Articles
Information
Cardiology in the Young , Volume 20 , Issue 2 , April 2010 , pp. 150 - 158
Copyright
Copyright © Cambridge University Press 2010

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