CHANGES IN RIGHT-VENTRICULAR FILLING DYNAMICS DURING LEFT ANTERIOR DESCENDING, LEFT CIRCUMFLEX AND RIGHT CORONARY-ARTERY BALLOON OCCLUSION

Aim Transient coronary artery occlusion during percutaneous translumin al coronary angioplasty may cause left ventricular diastolic dysfuncti on. The aim of this study was to evaluate the effect of left anterior descending, left circumflex and right coronary artery balloon occlusio n on right ventricular diastolic function. Methods Thirty-five patient s with single-vessel coronary artery disease and no previous myocardia l infarction were selected. Left and right ventricular filling pressur es were monitored by Doppler echocardiography and haemodynamic monitor ing. This was performed during and immediately after 60 s of coronary balloon occlusion of the left anterior descending artery in 21 cases ( Group 1), the left circumflex artery in eight cases (Group 2) and the right coronary artery in six cases (Group 3). Doppler analysis of left and right ventricular filling included peak velocity of early (PFVE) and late ventricular filling (PFVA) and PFVE to PFVA ratio (PFVE/PFVA) . Results In all three groups, balloon inflation induced a significant increase in left and right filling pressures (P<0.05). No qualitative difference in haemodynamic changes was found between groups during in flation. Significant impairment in the Doppler pattern of left and rig ht ventricular filling occurred after 20 s of coronary occlusion: PFVE values in mitral and tricuspid valves decreased by 14% and 25% in Gro up 1, 13% and 25% in Group 2, and 10% and 21% in in Group 3, respectiv ely. As PFVA remained unchanged in all groups, the PFVE/PFVA ratio of mitral and tricuspid valve flows significantly decreased (Group 1: -12 % and -20%, Group 2: -10% and -21%, Group 3: -14 and -21%, respectivel y). All parameters returned to baseline within 30 s after each balloon deflation. Conclusion Our data suggest that brief episodes of acute m yocardial ischaemia, such as these induced by 60 s of coronary artery occlusion during percutaneous transluminal coronary angioplasty, elici t simultaneous diastolic dysfunction of both ventricles, independent o f the coronary artery involved.