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Instantaneous diastolic pressure–flow relationship in arterial coronary bypass grafts

Published online by Cambridge University Press:  27 January 2006

S. Kazmaier ,
G.-G. Hanekop ,
M. Grossmann ,
H. Dörge ,
K. Götze ,
F. Schöndube ,
M. Quintel  and
A. Weyland
S. Kazmaier
Affiliation:
Georg-August-University, Department of Anesthesiology, Emergency Medicine and Intensive Care, Germany
G.-G. Hanekop
Affiliation:
Georg-August-University, Department of Anesthesiology, Emergency Medicine and Intensive Care, Germany
M. Grossmann
Affiliation:
Georg-August-University, Department of Cardiothoracic and Vascular Surgery, Göttingen Germany
H. Dörge
Affiliation:
Georg-August-University, Department of Cardiothoracic and Vascular Surgery, Göttingen Germany
K. Götze
Affiliation:
Georg-August-University, Department of Anesthesiology, Emergency Medicine and Intensive Care, Germany
F. Schöndube
Affiliation:
Georg-August-University, Department of Cardiothoracic and Vascular Surgery, Göttingen Germany
M. Quintel
Affiliation:
Georg-August-University, Department of Anesthesiology, Emergency Medicine and Intensive Care, Germany
A. Weyland
Affiliation:
Georg-August-University, Klinikum Oldenburg, Department of Anesthesiology and Intensive Care, Germany
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Abstract

Summary

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.

Keywords

CORONARY ARTERY BYPASS GRAFTINGCARDIOVASCULAR PHYSIOLOGYCORONARY CIRCULATION, blood flow
Type
EACTA Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 5 , May 2006 , pp. 373 - 379
Copyright
2006 European Society of Anaesthesiology

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