Noninvasive measurement of coronary artery blood flow using combined two-dimensional and Doppler echocardiography

Abstract

Noninvasive measurement of left anterior descending coronary artery flow was attempted in 20 normal subjects and 80 patients with cardiovascular disease (valvular heart disease in 34, ischemic heart disease in 26, cardiomyopathy in 15 and other diseases in 5) using combined two-dimensional and Doppler echocardiography. A tubular structure about 2 mm in diameter containing Doppler flow signals was identified in the anterior interventricular sulcus in 7 (35%) of the normal subjects and 40 (50%) of the patients with cardiovascular disease. The blood flow within the tubular structure exhibited a biphasic flow pattern, consisting of systolic and diastolic phases with higher velocity during diastole. The highest velocities were observed in early diastole and, in several cases, a small peak was detected during the atrial contraction phase. On the basis of its spatial orientation and characteristic flow pattern, the tubular structure was identified as the midportion of the left anterior descending coronary artery. In a number of cases it was difficult to detect the systolic blood flow. Although blood flow was normally directed from the cardiac base to the apex, it was reversed toward the base in the patients with a bypass graft to the left anterior descending coronary artery. In patients with severe aortic insufficiency, however, flow velocity was lower during diastole than during systole and the duration of diastolic flow was reduced, failing to continue to the end of diastole. Flow velocity was high in patients with a bypass graft to the left anterior descending coronary artery, aortic stenosis or hypertrophic cardiomyopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Doppler echocardiographic criteria in patency assessment of composite grafts from left internal thoracic artery

“…There are controversies regarding some variables measured by Doppler, but the integral of the mean velocity/time (VTI) is well accepted as an indicator of patency [6][7][8][9][10][11][12][13].…”

“…LITA has the ability to restore its patency after apparent occlusion in the progression of the coronary disease. Other conditions can influence LITA flow, including severe dysfunction of the left ventricle [6], coronary microcirculation disease, hypertrophy, fibrosis and myocardial viability [24,25]. TDE at stress can be very helpful in these situations and it can avoid a more invasive test [23].…”

“…The anatomical reasons include unfavorable configurations of the rib cage, the position and diameters of the LITA graft, and the mobility of the heart [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. The overlap of vessels in the supraclavicular block may also have impaired the visualization of LITA.…”

“…The first descriptions of using Doppler applications in CABG were reported by Fusejima [6], in 1987, and Takagi et al [7], in 1993. It is a noninvasive and low cost method, and of quick completion even at bedside setting.…”

Noninvasive Evaluation of Coronary Reperfusion by Transthoracic Doppler Echocardiography in Patients With Anterior Acute Myocardial Infarction Before Coronary Intervention

“…Since the initial coronary flow study with TTDE by Fusejima,10 TTDE has been applied to evaluate many aspects of coronary pathophysiology, including epicardial coronary stenosis, 13,14 coronary vasodilatory function, [15][16][17][18] coronary obstruction with collateral flow, 19 and intramyocardial small coronary artery flow dynamics. 12,20 The present study confirmed the feasibility of TTDE to evaluate coronary pathophysiology and further demonstrated its utility to differentiate TIMI 0 to 2 and TIMI 3 reperfusion in patients with anterior AMI.…”