The aim of this study was to assess the change in coronary flow in patients who underwent
percutaneous aortic valve replacement (PAVR) for severe aortic stenosis. The left
main coronary artery was visualized using transesophageal echocardiography in 17 patients
who underwent PAVR. The peak systolic and diastolic velocities of coronary flow and
the time-velocity integral were obtained before and after PAVR using pulsed-wave Doppler.
The median age was 80.0 years (interquartile range [IQR] 80.0 to 88.0). Median gradients
decreased from 40.0 mm Hg (IQR 35.0 to 50.0) before PAVR to 4.0 mm Hg (IQR 2.75 to
4.2) afterward (p <0.001). Aortic valve area increased from 0.6 cm2 (IQR 0.5 to 0.7) to 1.9 cm2 (IQR 1.7 to 2.0) (p <0.001). Cardiac output increased from 3.3 L/min (IQR 2.4 to
4.0) to 3.6 L/min (IQR 3.1 to 4.4) (p <0.001). Aortic systolic pressure did not change
significantly, from 126.0 mm Hg (IQR 11.7 to 137.7) before to 134 mm Hg (IQR 116.3
to 142.5) after valve implantation (p = 0.8). Left ventricular end-diastolic pressure
decreased significantly from 19.0 mm Hg (IQR 18.0 to 22.0) before to 14.0 mm Hg (IQR
12.0 to 17.0) after valve implantation (p = 0.01). The medians of the following coronary
flow parameters increased significantly after PAVR: peak systolic velocity, 25.0 cm/s
(IQR 17.0 to 30.0) to 37.0 cm/s (IQR 23.0 to 44.0) (p <0.001); peak diastolic velocity,
49.0 cm/s (IQR 39.5 to 61.0) to 57.0 cm/s (IQR 42.9 to 83.9) (p = 0.006); total velocity-time
integral, 23.7 cm (IQR 15.0 to 27.1) to 28.1 cm (IQR 21.3 to 34.7) (p = 0.001); and
systolic velocity-time integral, 5.4 cm (IQR 3.5 to 6.2) to 9.0 cm (IQR 4.5 to 9.8)
(p = 0.001). The diastolic time-velocity integral increased from 17.2 cm (IQR 12.0
to 24.0) to 20.1 cm (IQR 15.0 to 25.9) (p = 0.02). In conclusion, after PAVR, there
is a significant increase in coronary flow as measured by peak systolic velocity,
diastolic velocity, and velocity-time integral using pulsed-wave Doppler by transesophageal
echocardiography.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Decreased aortic distensibility and coronary flow velocity reserve in patients with significant aortic valve stenosis with normal epicardial coronary arteries.J Heart Valve Dis. 2004; 13: 567-573
- Stentless bioprostheses improve postoperative coronary flow more than stented prostheses after valve replacement for aortic stenosis.J Thorac Cardiovasc Surg. 2006; 131: 883-888
- The effect of aortic valve replacement on coronary flow reserve in patients with a normal coronary angiogram.Herz. 2002; 27: 780-784
- Coronary flow reserve improves after aortic valve replacement for aortic stenosis: an adenosine transthoracic echocardiography study.J Am Coll Cardiol. 2000; 36: 1889-1896
- Comparison of intracoronary Doppler guide wire and transesophageal echocardiography in measurement of flow velocity and coronary flow reserve in the left anterior descending coronary artery.Am Heart J. 1998; 135: 38-42
- Coronary vascular reserve in left ventricular hypertrophy.Am J Cardiol. 1979; 43: 379
- Quantitation of the turbulent stress distribution downstream of normal, diseased and artificial aortic valves in humans.Eur J Cardiothorac Surg. 1992; 6: 609-617
- Mechanisms of impaired coronary flow reserve in patients with aortic stenosis: transthoracic Doppler echocardiographic study.J Cardiol. 2004; 43: 173-178
- Mechanisms of coronary microcirculatory dysfunction in patients with aortic stenosis and angiographically normal coronary arteries.Circulation. 2002; 105: 470-476
- Impairment of coronary flow reserve in aortic stenosis.J Appl Physiol. 2009; 106: 113-121
- Surgical and percutaneous aortic valve replacement have different impact on diastolic phase in elderly patients with aortic valve stenosis.J Am Coll Cardiol. 2009; 53: A403-A418
Article info
Publication history
Published online: July 21, 2009
Accepted:
May 2,
2009
Received in revised form:
May 2,
2009
Received:
March 17,
2009
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
