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Restricted coronary flow reserve in patients with mitral regurgitation improves after mitral reconstructive surgery¹

Takashi Akasaka, MD^*, Kiyoshi Yoshida, MD, FACC^*, Takeshi Hozumi, MD^*, Tsutomu Takagi, MD^*, Shuichiro Kaji, MD^*, Takahiro Kawamoto, MD^*, Yoshiaki Ueda, MD^*, Yukikatsu Okada, MD, Shigefumi Morioka, MD^* and Junichi Yoshikawa, MD, FACC

^* Department of Cardiology, Kobe General Hospital, Kobe, Japan
Department of Cardiovascular Surgery, Kobe General Hospital, Kobe, Japan
First Department of Internal Medicine, Osaka City University School of Medicine, Osaka, Japan

View larger version (20K): [in a new window]   Figure 1 Scatterplot of coronary flow reserve and baseline time-averaged peak velocity (APV). Significant linear correlations between coronary flow reserve and baseline coronary flow velocity are observed with substantial scatter. Dotted line indicates 90% confidence bands.

View larger version (29K): [in a new window]   Figure 2 Scatterplots of coronary flow reserve and left ventricular end-diastolic pressure (LVEDP), left ventricular end-diastolic volume index, left ventricular mass index (LVEDVI) and mitral regurgitant volume. Significant linear correlations between coronary flow reserve and LVEDP, LVEDVI, LVMI and mitral regurgitant volume are observed with substantial scatter. Dotted lines indicate 90% confidence bands.

View larger version (91K): [in a new window]   Figure 3 Examples of coronary flow velocity recordings in the proximal left anterior descending coronary artery at baseline (left panels) and during hyperemia (right panels) in a case with mitral regurgitation before (upper panels; Pre-op) and after (lower panels; Post-op) mitral reconstructive surgery. Baseline flow velocity decreases and coronary flow reserve increases after mitral reconstructive surgery compared with those before surgery. APV = time-averaged peak velocity; FR = coronary flow reserve.

View larger version (20K): [in a new window]   Figure 4 Baseline (left panel) and maximal hyperemic (middle panel) coronary flow velocities and coronary flow reserve (right panel) in 13 cases with mitral regurgitation before and after mitral reconstructive surgery. Compared with those before surgery, there are no significant differences in hyperemic time-averaged peak velocities after surgery, although baseline flow velocities significantly decrease uniformly in all cases after reconstructive surgery. As the result, coronary flow reserve increases significantly in all cases after surgery compared with that before surgery. APV = time-averaged peak velocity; CFR = coronary flow reserve.