TY  - BOOK
AU  - Ben-Dor, Itsik
AU  - Goldstein, Steven A
AU  - Lindsay, Joseph
AU  - Magalhaes, Marco A
AU  - Malik, Rahul
AU  - Minha, Sa'ar
AU  - Okubagzi, Petros
AU  - Pichard, Augusto D
AU  - Satler, Lowell F
AU  - Torguson, Rebecca
AU  - Waksman, Ron
AU  - Wang, Zuyue
AU  - Weissman, Gaby
TI  - Coronary blood flow in patients with severe aortic stenosis before and after transcatheter aortic valve implantation
SN  - 0002-9149
PY  - 2014///
KW  - *Aortic Valve Stenosis/pp [Physiopathology]
KW  - *Cardiac Catheterization
KW  - *Coronary Circulation/ph [Physiology]
KW  - *Coronary Vessels/pp [Physiopathology]
KW  - *Heart Valve Prosthesis Implantation/mt [Methods]
KW  - *Regional Blood Flow/ph [Physiology]
KW  - Aged, 80 and over
KW  - Aortic Valve Stenosis/su [Surgery]
KW  - Aortic Valve Stenosis/us [Ultrasonography]
KW  - Coronary Vessels/us [Ultrasonography]
KW  - Echocardiography, Doppler
KW  - Echocardiography, Transesophageal
KW  - Feasibility Studies
KW  - Female
KW  - Follow-Up Studies
KW  - Humans
KW  - Male
KW  - Postoperative Period
KW  - Preoperative Period
KW  - Prognosis
KW  - Retrospective Studies
KW  - Severity of Illness Index
KW  - Treatment Outcome
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
N2  - 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
UR  - http://dx.doi.org/10.1016/j.amjcard.2014.07.054
ER  -