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Instantaneous diastolic pressure–flow relationship in arterial coronary bypass grafts

  • S. Kazmaier (a1), G.-G. Hanekop (a1), M. Grossmann (a2), H. Dörge (a2), K. Götze (a1), F. Schöndube (a2), M. Quintel (a1) and A. Weyland (a3)...



Objective: The objective of this study was to describe the diastolic pressure–flow relationship and to assess critical occlusion pressure in arterial coronary bypass grafts in human beings. Methods and results: Fifteen patients were studied following elective surgical coronary artery bypass grafting. Flow in the left internal mammary artery bypass to the left anterior descending artery was measured and simultaneously, aortic pressure, coronary sinus pressure and left ventricular end-diastolic pressure were recorded. The zero-flow pressure intercept as a measure of critical occlusion pressure was extrapolated from the linear regression analysis of the instantaneous diastolic pressure–flow relationship. Mean diastolic flow was 46 ± 17 mL min−1, mean diastolic aortic pressure was 60.5 ± 10.0 mmHg. Diastolic blood flow was linearly related to the respective aortic pressure in all patients (R-values 0.7–0.99). The regression lines had a mean slope of 2.1 ± 1.2 mL min−1 mmHg−1. Mean critical occlusion pressure was 32.3 ± 9.9 mmHg and exceeded mean coronary sinus pressure and mean left ventricular end-diastolic pressure by factors of 3.1 and 2.6, respectively. Conclusions: Our data demonstrate the presence of a vascular waterfall phenomenon in the coronary circulation after internal mammary artery bypass grafting. Critical occlusion pressure in arterial grafts considerably exceeds coronary sinus pressure as well as left ventricular end-diastolic pressure and should thus be used as the effective downstream pressure when calculating coronary perfusion pressure. Our data further suggest that the slope of diastolic pressure–flow relationships provides a more rational approach to assess regional coronary vascular resistance than conventional calculations of coronary vascular resistance.


Corresponding author

Correspondence to: Stephan Kazmaier, Department of Anesthesiology, Emergency Medicine and Intensive Care, Georg-August-University of Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany. E-mail:; Tel: +49 551 392995; Fax: +49 551 398676


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Permutt S, Riley RL. Hemodynamics of collapsible vessels with tone: the vascular waterfall. J Appl Physiol 1963; 18: 924932.
Jackman AP, Green JF. A theoretical description of arterial pressure–flow relationships with verification in the isolated hindlimb of the dog. Ann Biomed Eng 1990; 18: 89101.
Bellamy RF. Diastolic coronary artery pressure–flow relations in the dog. Circ Res 1978; 43: 92101.
Uhlig PN, Baer RW, Vlahakes GJ, Hanley FL, Messina LM, Hoffman JI. Arterial and venous coronary pressure–flow relations in anesthetized dogs. Evidence for a vascular waterfall in epicardial coronary veins. Circ Res 1984; 55: 238248.
Farhi ER, Klocke FJ, Mates REet al. Tone-dependent waterfall behavior during venous pressure elevation in isolated canine hearts. Circ Res 1991; 68: 392401.
Ejaz T, Takemae T, Kosugi Y, Hongo M. The high zero-flow pressure phenomenon in coronary circulation: a simulation study. Front Med Biol Eng 2002; 11: 335340.
Dole WP, Richards KL, Hartley CJ, Alexander GM, Campbell AB, Bishop VS. Diastolic coronary artery pressure–flow velocity relationships in conscious man. Cardiovasc Res 1984; 18: 548554.
Nanto S, Masuyama T, Hori M, Shimonagata T, Ohara T, Kubori S. Zero flow pressure in human coronary circulation. Angiology 1996; 47: 115122.
Nanto S, Masuyama T, Takano Y, Hori M, Nagata S. Determination of coronary zero flow pressure by analysis of the baseline pressure–flow relationship in humans. Japan Circ J 2001; 65: 793796.
D'Ancona G, Karamanoukian HL, Ricci M, Bergsland J, Salerno TA. Graft patency verification in coronary artery bypass grafting: principles and clinical applications of transit time flow measurement. Angiology 2000; 51: 725731.
Groom R, Tryzelaar J, Forest Ret al. Intra-operative quality assessment of coronary artery bypass grafts. Perfusion 2001; 16: 511518.
Walpoth BH, Bosshard A, Kipfer B, Berdat PA, Althaus U, Carrel T. Failed coronary artery bypass anastomosis detected by intraoperative coronary flow measurement. Eur J Cardiothorac Surg 1998; 14 (Suppl 1): S76S81.
Klocke FJ, Weinstein IR, Klocke JFet al. Zero-flow pressures and pressure–flow relationships during single long diastoles in the canine coronary bed before and during maximum vasodilation. Limited influence of capacitive effects. J Clin Invest 1981; 68: 970980.
Douglas JE, Greenfield JrJC. Epicardial coronary artery compliance in the dog. Circ Res 1970; 27: 921929.
Klocke FJ, Ellis AK, Orlick AE. Sympathetic influences on coronary perfusion and evolving concepts of driving pressure, resistance, and transmural flow regulation. Anesthesiology 1980; 52: 15.
Beldi G, Bosshard A, Hess OM, Althaus U, Walpoth BH. Transit time flow measurement: experimental validation and comparison of three different systems. Ann Thorac Surg 2000; 70: 212217.
D'Ancona G, Karamanoukian HL, Salerno TA, Schmid S, Bergsland J. Flow measurement in coronary surgery. Heart Surg Forum 1999; 2: 121124.
Wolfe JA. The coronary artery bypass conduit: II. Assessment of the quality of the distal anastomosis. Ann Thorac Surg 2001; 72: S2253S2258.
Schmitz C, Ashraf O, Schiller Wet al. Transit time flow measurement in on-pump and off-pump coronary artery surgery. J Thorac Cardiovasc Surg 2003; 126: 645650.
Shimada K, Sakanoue Y, Kobayashi Yet al. Assessment of myocardial viability using coronary zero flow pressure after successful angioplasty in patients with acute anterior myocardial infarction. Heart 2003; 89: 7176.
Furber AP, Prunier F, Nguyen HC, Boulet S, Delepine S, Geslin P. Coronary blood flow assessment after successful angioplasty for acute myocardial infarction predicts the risk of long-term cardiac events. Circulation 2004; 110: 35273533.
Franke UF, Korsch S, Wittwer Tet al. Intermittent antegrade warm myocardial protection compared to intermittent cold blood cardioplegia in elective coronary surgery – do we have to change? Eur J Cardiothorac Surg 2003; 23: 341346.
Elvenes OP, Korvald C, Myklebust R, Sorlie D. Warm retrograde blood cardioplegia saves more ischemic myocardium but may cause a functional impairment compared to cold crystalloid. Eur J Cardiothorac Surg 2002; 22: 402409.
Jin XY, Gibson DG, Pepper JR. The effects of cardioplegia on coronary pressure–flow velocity relationships during aortic valve replacement. Eur J Cardiothorac Surg 1999; 16: 324330.


Instantaneous diastolic pressure–flow relationship in arterial coronary bypass grafts

  • S. Kazmaier (a1), G.-G. Hanekop (a1), M. Grossmann (a2), H. Dörge (a2), K. Götze (a1), F. Schöndube (a2), M. Quintel (a1) and A. Weyland (a3)...


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