The effect of intracoronary injection of contrast medium upon coronary blood flow.

Abstract

The changes in coronary blood flow in response to intracoronary injection of 3 ml of 76% Renografin were studied in 47 patients using the thermodilution technique for continuous measurement of coronary sinus blood flow. Within seconds after left coronary injection, an increase in coronary sinus flow began which peaked at an average of 53% above control in 5-10 seconds. There was a corresponding decrease in coronary resistance. Flow returned to control level in almost all patients within one minute of injection. Twenty-four of 35 patients had no change in coronary sinus flow in response to right coronary injection. This can be explained by the fact that most of the venous flow from the right coronary artery returns in such a way that it cannot be measured by the coronary sinus catheter. Of the eleven patients who did show an increase, seven had angiographically documented right to left collaterals, suggesting that the increase in flow was the result of vasodilatation of the left coronary bed by contrast arriving via the right to left collaterals. The percent changes in flow and resistance in response to left coronary injection were isgnificantly greater in the 13 normals than in the 34 with obstructive disease of the left coronary artery (P lessthan 0.01). Flow rose 70 plus or minus 27% (mean plus or minus standard deviation) in the normals versus 46 plus or minus 25% in the patients with coronary artery disease, while resistance fell 44 plus or minus 9% versus 33 plus or minus 11%. The differences, however, were not sufficient for these changes to be of value in the assessment of the degree of impairment of the coronary arterial bed in the individual patient.

Non surgical coronary artery recanalization in acute transmural myocardial infarction.

“…So far, 10 patients, mean age 53.7 years (range 28-67 years), underwent uneventful bypass surgery 1-7 days after recanalization. A hemorrhagic infarct was not seen at the time of surgery.…”

Modulation of Sympathetic Coronary Vasoconstriction by Cardiac Renin-Angiotensin System in Human Coronary Heart Disease

“…This was accompanied by lesser oxygen desaturation and reduction in PO 2 in the blood refluent from the heart, indicating that the sympathoinhibitory effect of local ACE inhibition plays a favorable metabolic role insofar as it allows the increased oxygen demand to be more adequately met. It should be emphasized that this occurred together with an increase in the calculated 11 MV O 2 greater than that observed when the cold pressor test was performed under saline infusion. It is therefore possible that metabolic factors also participated in the attenuated sympathetic vasoconstrictor influences that were seen after ACE inhibition.…”

“…Cardiac catheterization was performed in the morning after an overnight fast. The study proper began 45 minutes after completion of cardiac catheterization (to minimize the effect of contrast medium on coronary and systemic circulations 11 ) with the positioning of the thermodilution catheter in the coronary sinus and the advancement of a 6F left Judkins catheter from the femoral artery to the ostium of the left main trunk. Blood pressure, heart rate, and coronary blood flow were measured (1) 3 to 4 times both before and after 15 minutes of infusion of saline in the left main trunk at the rate of 60 mL/h and (2) while saline continued to be infused immediately before and at the end of a cold pressor test (2-minute immersion of one patient's hand into melting ice water, nϭ14) or a diving maneuver (30-second positioning of a thin plastic bag filled with ice and water to the patient's nose and mouth, nϭ8).…”

Detection of Coronary Microembolization by Doppler Ultrasound in Patients With Stable Angina Pectoris Undergoing Elective Percutaneous Coronary Interventions

“…Frequent injection of contrast agent can reduce CFVR by increasing postprocedural baseline APV 33,34 ; however, the amount of contrast medium did not differ significantly between groups.…”