Evaluation of the coronary arteries in the foetus and newborn and their physiologic significance

Abstract

Objective: To review the current literature addressing the visualisation and clinical applicability of coronary artery blood flow in various foetal and neonatal settings.

Method: We reviewed original research papers, commentaries and review articles which studied the usefulness of coronary flow assessments in the growth restricted foetus, healthy neonates and neonates with clinical conditions such as asphyxia, congenital heart disease and post-surgical duct ligation myocardial failure.

Results: Relevant literature showed that visualisation of coronary blood flow in growth restricted foetuses is considered an ominous sign and identifies a subgroup of foetuses with a poorer foetal and neonatal outcome. A direct relationship between coronary blood flow and echocardiographic parameters in healthy term infants was noted. These assessments also provided useful information in infants with heart disease and perinatal asphyxia. Coronary perfusion has been noted as an important haemodynamic marker in the peri-operative evaluation of preterm infants undergoing surgical duct ligation.

Conclusions: The available literature suggests that these assessments play an important role in improving the understanding of the underlying clinical physiology of the disease process in both the foetus and the newborn. Future research should focus on the evolution of coronary blood flow in clinical situations such as hypotension and inotropic support.