Changes in right ventricular filling dynamics during left anterior descending, left circumflex and right coronary artery balloon occlusion

• Published in: European heart journal Vol. 18; no. 9; pp. 1432 - 1437
• Main Authors: Fabbiocchi, F., Galli, C., Doria, E., Sganzerla, P., Montorsi, P., Loaldi, A., de Cesare, N., Bartorelli, A. L.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.09.1997
• Subjects: Angioplasty, Balloon, Coronary; Biological and medical sciences; Blood Flow Velocity; diastolic function; Diseases of the cardiovascular system; Doppler echocardiography; Echocardiography, Doppler; Electrocardiography; Female; Hemodynamics; Humans; Male; Medical sciences; Middle Aged; Myocardial Ischemia - etiology; Myocardial Ischemia - physiopathology; PTCA; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Regional Blood Flow; Ventricular Dysfunction, Right - diagnostic imaging; Ventricular Dysfunction, Right - physiopathology; Sonography; Human; Diastole; Right ventricle; Instrumentation therapy; Right ventricle performance; Instrumental dilatation; Duplex ultrasonography; Right coronary artery; Treatment; Medical imagery; Complication; Filling; Circumflex artery; Anterior intraventricular artery
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/oxfordjournals.eurheartj.a015469

Aim Transient coronary artery occlusion during percutaneous transluminal coronary angioplasty may cause left ventricular diastolic dysfunction. The aim of this study was to evaluate the effect of left anterior descending, left circumflex and right coronary artery balloon occlusion on right ventricular diastolic function. Methods Thirty-five patients with single-vessel coronary artery disease and no previous myocardial infarction were selected. Left and right ventricular filling pressures were monitored by Doppler echocardiography and haemodynamic monitoring. 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 inflation. Significant impairment in the Doppler pattern of left and right ventricular filling occurred after 20 s of coronary occlusion: PFVE values in mitral and tricuspid valves decreased by 14% and 25% in Group 1, 13% and 25% in Group 2, and 10% and 21% in Group 3, respectively. 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%, respectively). All parameters returned to baseline within 30 s after each balloon deflation. Conclusion Our data suggest that brief episodes of acute myocardial ischaemia, such as those induced by 60 s of coronary artery occlusion during percutaneous transluminal coronary angioplasty, elicit simultaneous diastolic dysfunction of both ventricles, independent of the coronary artery involved.