What is the role of the aorta in directing coronary blood flow? | Heart

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What is the role of the aorta in directing coronary blood flow?

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The influence of a stiff aorta on the coronary supply-demand balance to the heart
Tomoaki MURAKAMI
Published on: 21 January 2009

Published on: 21 January 2009
The influence of a stiff aorta on the coronary supply-demand balance to the heart
- Tomoaki MURAKAMI, MD
- Other Contributors:
  Yasuko MORIMOTO, MD
Dear Editor, The recent article by Davies and colleagues (1) discussed the role of aorta in directing coronary circulation. They mainly treated the subject from the viewpoint of blood pressure, however, there remains a further point which needs to be clarified: namely, the coronary blood flow. The aorta serves predominantly as a cushioning reservoir of blood during systole, and thereafter expelling it to the peripheral c...
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Dear Editor, The recent article by Davies and colleagues (1) discussed the role of aorta in directing coronary circulation. They mainly treated the subject from the viewpoint of blood pressure, however, there remains a further point which needs to be clarified: namely, the coronary blood flow. The aorta serves predominantly as a cushioning reservoir of blood during systole, and thereafter expelling it to the peripheral circulation during diastole (reservoir function). One of the most important organs to be supplied blood in diastole is the heart. A decreased aortic compliance therefore increases the risk of subendocardial ischemia (2), and recent studies have also shown a relationship between the aortic reservoir function and ischemic heart disease (3,4). Moreover, a rigid aorta increases the afterload of the heart. Therefore, a coronary supply-demand imbalance of the heart could thus occur, even if the diastolic blood pressure is maintained. We previously analyzed the aortic reservoir function in pediatric patients after undergoing an arterial switch operation, whose ascending aorta was dilated and its distensibility had markedly decreased, similarly to that observed in elderly individuals. (5-7). Their pulse pressure had also increased in comparison to normal subjects (5). However, their subendocardial viability ratio, which means the coronary supply-demand balance of the heart, was the same as that observed in the control group. Their subendocardial viability ratio closely correlated with the percentage of the diastolic runoff, which is the percentage of the diastolic blood flow to a total cardiac output (r = 0.872, p <0.0001). The reason why the aortic reservoir function was maintained in patients with a decreased aortic distensibility may be due to the fact that the aorta was dilated. Although its distensibility decreased, an expanded aorta may therefore be able to store enough blood during systole, which resembles the compensation of a failing heart; namely, although the left ventricular ejection fraction decreases, the increased left ventricular end-diastolic volume can maintain a sufficient cardiac output. The coronary supply-demand balance is crucial for life. As a result, various types of compensatory mechanisms are thus considered to exist. Regarding coronary circulation, the importance of the aortic diastolic blood pressure (coronary driving pressure) cannot therefore be overemphasized. However, the coronary blood flow, and the coronary supply- demand balance should also be taken into consideration when analyzing this problem.
References
1. Davies JE, Parker KH, Francis DP, et al. What is the role of the aorta in directing coronary blood flow? Heart. 2008;94:1545-1547
2. Watanabe H, Ohtsuka S, Kakihana M, et al. Coronary circulation in dogs with an experimental decrease in aortic compliance. J Am Coll Cardiol 1993;21:1497-1506
3.Franklin S, Larson M, Khan S, et al. Does the relation of blood pressure to coronary heart disease risk change with aging?: The Framingham Heart Study. Circulation 2001;103:1245-1249
4.Sisso H, Stampfer M, Rosner B, et al. Systolic and diastolic blood pressure, pulse pressure, and mean arterial pressure as predictors of cardiovascular disease risk in men. Hypertension 2000;36:801-807
5.Murakami T, Takei K, Ueno M, et al. Aortic reservoir function after arterial switch operation in elementary school-aged children. Circ J. 2008;72:1291-1295
6.Sievers H, Lange P, Arensman F, et al. Influence of two-stage anatomic correction on size and distensibility of the anatomic pulmonary/functional aortic root in patients with simple transposition of the great arteries. Circulation. 1984;70:202-208
7.Murakami T, Nakazawa M, Momma K, et al. Impaired distensibility of neoaorta after arterial switch procedure. Ann Thorac Surg. 2000;70:1907-1910
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Conflict of Interest:
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