CORONARY FLOW VELOCITY RESERVE AFTER SUCCESSFUL BALLOON ANGIOPLASTY AND DIRECTIONAL ATHERECTOMY

Background: To ascertain whether transesophageal echocardiography (TEE ) allows for measurement of coronary flow velocity ''reserve'' in pati ents with disease of the left anterior descending artery (LAD), and to establish the flow velocity response following angiographically succe ssful angioplasty and atherectomy. Methods: Pour groups of patients we re studied: normal controls (n = 15) consisted of patients without obs tructive coronary artery disease, a LAD stenosis group (it = 15) consi sted of patients with > 70% stenosis, an LAD postangiographically succ essful balloon angioplasty group (n = 12), and an LAD postangiographic ally successful directional atherectomy group (n = 6). Two-dimensional horizontal plane TEE was used to image the proximal left coronary art erial system. Pulsed Doppler recordings were made of proximal LAD flow velocities at rest, and following an infusion of 0.56 mg/kg IV dipyri damole. Results: The peak diastolic flow, velocity ratio (hyperemic fl ow/baseline flow) for normal controls was 3.46 +/- 0.48 (mean +/- stan dard deviation), for the LAD stenosis group was 1.35 +/- 0.26, for the balloon angioplasty group was 2.08 +/- 0.45, and for the directional atherectomy group was 2.10 +/- 0.82. Conclusions: We conclude that: (1 ) it is feasible to record with TEE Doppler, flow velocity and flow re serve in normals, in obstructive coronary artery disease, and followin g revascularization; (2) coronary flow velocity ratio (CFVR) is decrea sed in patients with LAD stenosis; (3) CFVR remains subnormal in patie nts with angiographically successful directional atherectomy and ballo on angioplasty; and (4) that flow velocity ratios following directiona l atherectomy were not significantly different from those following ba lloon angioplasty.