MedStar Authors catalog › Details for: Coronary blood flow in patients with severe aortic stenosis before and after transcatheter aortic valve implantation.
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Coronary blood flow in patients with severe aortic stenosis before and after transcatheter aortic valve implantation.

by Ben-Dor, Itsik; Malik, Rahul; Minha, Sa'ar; Goldstein, Steven A; Wang, Zuyue; Magalhaes, Marco A; Weissman, Gaby; Okubagzi, Petros; Torguson, Rebecca; Lindsay, Joseph; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron.
Citation: American Journal of Cardiology. 114(8):1264-8, 2014 Oct 15..Journal: The American journal of cardiology.ISSN: 0002-9149.Full author list: Ben-Dor I; Malik R; Minha S; Goldstein SA; Wang Z; Magalhaes MA; Weissman G; Okubagzi PG; Torguson R; Lindsay J; Satler LF; Pichard AD; Waksman R.UI/PMID: 25173443.Subject(s): Aged, 80 and over | *Aortic Valve Stenosis/pp [Physiopathology] | Aortic Valve Stenosis/su [Surgery] | Aortic Valve Stenosis/us [Ultrasonography] | *Cardiac Catheterization | *Coronary Circulation/ph [Physiology] | *Coronary Vessels/pp [Physiopathology] | Coronary Vessels/us [Ultrasonography] | Echocardiography, Doppler | Echocardiography, Transesophageal | Feasibility Studies | Female | Follow-Up Studies | *Heart Valve Prosthesis Implantation/mt [Methods] | Humans | Male | Postoperative Period | Preoperative Period | Prognosis | *Regional Blood Flow/ph [Physiology] | Retrospective Studies | Severity of Illness Index | Treatment OutcomeInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: (Click here) Abbreviated citation: Am J Cardiol. 114(8):1264-8, 2014 Oct 15.Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006.Abstract: Patients with severe aortic stenosis and no obstructed coronary arteries are reported to have reduced coronary flow. Doppler evaluation of proximal coronary flow is feasible using transesophageal echocardiography. The present study aimed to assess the change in coronary flow in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). The left main coronary artery was visualized using transesophageal echocardiography in 90 patients undergoing TAVI using the Edwards SAPIEN valve. The peak systolic and diastolic velocities of the coronary flow and the time-velocity integral were obtained before and after TAVI using pulse-wave Doppler. Mean aortic gradients decreased from 47.1 +/- 15.7 mm Hg before TAVI to 3.6 +/- 2.6 mm Hg after TAVI (p <0.001). The aortic valve area increased from 0.58 +/- 0.17 to 1.99 +/- 0.35 cm(2) (p <0.001). The cardiac output increased from 3.4 +/- 1.1 to 3.8 +/- 1.0 L/min (p <0.001). Left ventricular end-diastolic pressure (LVEDP) decreased from 19.8 +/- 5.4 to 17.3 +/- 4.1 mm Hg (p <0.001). The following coronary flow parameters increased significantly after TAVI: peak systolic velocity 24.2 +/- 9.3 to 30.5 +/- 14.9 cm/s (p <0.001), peak diastolic velocity 49.8 +/- 16.9 to 53.7 +/- 22.3 cm/s (p = 0.04), total velocity-time integral 26.7 +/- 10.5 to 29.7 +/- 14.1 cm (p = 0.002), and systolic velocity-time integral 6.1 +/- 3.7 to 7.7 +/- 5.0 cm (p = 0.001). Diastolic time-velocity integral increased from 20.6 +/- 8.7 to 22.0 +/- 10.1 cm (p = 0.04). Total velocity-time integral increased >10% in 43 patients (47.2%). Pearson's correlation coefficient revealed the change in LVEDP as the best correlate of change in coronary flow (R = -0.41, p = 0.003). In conclusion, TAVI resulted in a significant increase in coronary flow. The change in coronary flow was associated mostly with a decrease in LVEDP.Copyright � 2014 Elsevier Inc. All rights reserved.

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