Effect of intravenous dipyridamole on coronary flow parameters in patients with isolated coronary artery ectasia: assessment by transesophageal echocardiography.

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.

Assessment of coronary flow parameters by transesophageal echocardiography in patients with isolated coronary artery ectasia: effect of intravenous nitroglycerin.

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.

Percutaneous mitral valvotomy versus closed surgical commissurotomy. Up to 15 years of follow-up of a prospective randomized study.

BACKGROUND: Immediate and intermediate term results of percutaneous mitral valvotomy (PMV) are comparable to closed surgical commissurotomy (CSC). We aimed at exploring this relation in the long term. METHODS: Previously, we randomized 40 consecutive patients with moderate to severe mitral stenosis [defined as mitral valve area (MVA) less than 1.5 cm²] to undergo either PMV (PMV group = 20 patients) or CSC (CSC group = 20 patients). For all patients, full echocardiographic assessment was performed before the procedure/operation. Patients assigned to PMV underwent the double balloon technique. Echocardiographic assessment was done following both procedures before discharge and repeated 1 and 6 months later. Echocardiographic follow-up was performed, thereafter, on a yearly basis for up to 15 years, with a mean follow-up period of 99 ± 12 months. RESULTS: Immediate echocardiographic results showed no statistically significant difference between the 2 groups regarding the final MVA or mean diastolic gradient across the mitral valve. Two patients dropped out from the CSC group and one from the PMV group. MVA was 1.8 ± 0.3 cm² versus 1.8 ± 0.4 cm² (p > 0.05) and mean diastolic pressure gradient across the mitral valve was 7 ± 4 mmHg versus 6.6 ± 4 mmHg (p > 0.05) in the PMV and CSC groups, respectively. Mitral restenosis occurred in 5 (26.3%) patients in the PMV group versus 5 (27.8%) patients in the CSC group (p > 0.05). Kaplan-Meier curves for restenosis-free survival showed no difference between the 2 groups. CONCLUSION: PMV achieves comparable results to CSC both in the short and long term.