ABSTRACT
BACKGROUND: In a prospective study design, we sought to assess the effect of dipyridamole on coronary flow parameters in patients with isolated coronary artery ectasia (CAE) as compared to subjects with normal coronaries. METHODS: We enrolled 30 patients with ectasia of the left anterior descending (LAD) artery (study group), and 10 subjects with normal coronaries (control group). All subjects underwent transesophageal echocardiography to record flow velocities in the proximal LAD coronary artery, and velocity time integrals were calculated. The diameter of the proximal LAD coronary artery was measured and flow was calculated. Dipyridamole (0.56 mg/kg) was administered intravenously and measurements were repeated 5 minutes later. RESULTS: At baseline, systolic and diastolic velocities, systolic, diastolic, and total velocity time integrals were significantly higher in the control group (P < 0.05 for all), yet, systolic, diastolic, and total coronary flow were significantly higher in the study group (P < 0.05 for all). Following dipyridamole administration, systolic, diastolic, and total coronary flow were still significantly higher in the study group (P < 0.05 for all), yet, there was no significant difference between the two groups regarding the other parameters, and regarding coronary reserve values (P > 0.05 for all). CONCLUSIONS: We concluded that patients with isolated CAE have a higher resting coronary flow as compared to control subjects with normal coronaries. Intravenous dipyridamole administration in these patients maintained a significantly higher coronary flow, with a coronary flow reserve similar to controls.
Subject(s)
Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/physiopathology , Coronary Circulation/drug effects , Dipyridamole , Echocardiography, Transesophageal/methods , Vasodilator Agents , Dilatation, Pathologic/diagnostic imaging , Dilatation, Pathologic/physiopathology , Dipyridamole/administration & dosage , Female , Humans , Injections, Intravenous , Male , Middle Aged , Reproducibility of Results , Sensitivity and Specificity , Vasodilator Agents/administration & dosageABSTRACT
BACKGROUND: We sought to assess coronary flow parameters in patients with isolated coronary artery ectasia (CAE) as compared to subjects with normal coronaries. METHODS: Consecutively, we enrolled 30 patients with ectasia of the left anterior descending (LAD) coronary artery (study group), and 10 subjects with normal coronaries (control group). All patients underwent transesophageal echocardiography to visualize the LAD. Spectral recordings of proximal LAD flow velocities were made and velocity time integrals were calculated. The diameter of the proximal LAD was measured and LAD blood flow was calculated. Nitroglycerin (0.3 mg) was administered intravenously and measurements were repeated 5 minutes later. RESULTS: The mean age of the whole series was 48.6 ± 8 years, 39 (97.5%) being males. A significantly higher baseline systolic, diastolic, and total coronary blood flow was found in the study group as compared to the control group (46.1 ± 34.3 vs. 23.1 ± 8.2, 123.9 ± 73.3 vs. 68.1 ± 21.6, 170.1 ± 97.9 vs. 91.1 ± 26.8 cm(3) /min, respectively, P < 0.05 for all). Within the study group, nitroglycerin administration caused a significant decrease in peak diastolic velocity; systolic, diastolic, and total velocity time integrals; and both diastolic and total coronary blood flow (P < 0.05 for all). Meanwhile, within the control group, nitroglycerin administration caused a significant increase in the total coronary blood flow (P < 0.05). CONCLUSIONS: Patients with CAE have higher resting coronary blood flow in comparison with subjects with normal coronaries. Intravenous nitroglycerin administration causes significant reduction of coronary blood flow in ectatic coronary arteries.
Subject(s)
Coronary Circulation , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/drug therapy , Dilatation, Pathologic/diagnostic imaging , Dilatation, Pathologic/drug therapy , Echocardiography, Transesophageal/methods , Nitroglycerin/administration & dosage , Female , Humans , Injections, Intravenous , Male , Middle Aged , Reproducibility of Results , Sensitivity and Specificity , Vasodilator Agents/administration & dosageABSTRACT
AIMS: We sought to explore the immediate and long-term outcome of combined percutaneous valvuloplasty of the mitral and/or aortic and/or tricuspid valves in a series of patients with rheumatic valvular stenosis. METHODS AND RESULTS: A total of 11 patients (three underwent percutaneous mitral valvuloplasty [PMV], percutaneous aortic valvuloplasty [PAV] and percutaneous tricuspid valvuloplasty [PTV], six underwent PMV and PAV, and two underwent PMV and PTV) were enrolled. PMV was performed by the standard double balloon technique. PAV was always performed after PMV, employing the retrograde approach in eight patients and the antegrade approach in one patient. PTV was performed by the double balloon technique. Echocardiographic assessment was performed before and after the procedures. Follow-up was performed in all patients for a period that ranged from 12 and up to 60 months. PMV was successful in 10 out of 11 cases (91%); PAV was successful in all nine procedures (100%), while PTV was successful in four out of five cases (80%). At long-term follow-up, one case of restenosis occurred following PMV (9%), two following PTV (40%), and no restenosis occurred following PAV. CONCLUSIONS: Percutaneous balloon dilatation of rheumatic valvular stenosis is feasible with fairly adequate immediate and long-term outcome.
