Towards measurement of coronary blood flow in patients and its alteration by interventions

Aim Several methods of measuring coronary blood flow in intact conscious ma n are reviewed, on the basis of personal contributions or the experiences o f our teams. Methods and Results It is important to distinguish between global, regional and transmural blood flow measurements. The advantages and limitations of the following methods are discussed: diffusible inert and radioactive trace rs, dye dilution, roentgendensitometry, magnetic resonance imaging and cont rast echocardiography. In interventional cardiology it is most important to be able to measure flow through single coronary vessels. Information on co ronary artery Doppler velocity during vasodilation and at rest is less usef ul than the concept of fractional flow reserve. This is based on pressure m easurements under maximal vasodilation to ascertain the presence of borderl ine flow-limiting lesions. This information is necessary in order to decide whether to proceed with angioplasty or not. Conclusions The historical design of percutaneous coronary angioplasty and beta-irradiation of coronary restenosis, established under the author's gui dance, are put into perspective. The author pays tribute to many excellent colleagues who worked with him at the Zurich and Geneva University Hospital s.