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This study examined the feasibility of Doppler transesophageal echocardiography (TEE) to detect collateral flow to the myocardium supplied by the right coronary artery (RCA) in the inferior left ventricular wall. Forty-four patients who underwent elective coronary artery bypass grafting (CABG) were prospectively studied. Presence of collateral flow to the RCA was diagnosed on preoperative angiography using the Rentrop score and by intraoperative Doppler TEE. Agreement of the 2 methods was analyzed by calculating the κ coefficient. Collateral flow was present on preoperative angiography in 19 patients and absent in 25 patients. Intraoperative TEE detected collateral flow in the inferior wall in 15 patients (79%) with and 3 patients (12%) without angiographic collaterals, resulting in a κ coefficient for agreement of 0.67 (95% confidence interval 0.45 to 0.90). Baseline collateral flow disappeared after CABG in 12 of 14 patients with grafting of the RCA but persisted in all patients without such grafting. Physiologic flow in the inferior wall was detected by TEE in a total of 27 patients at baseline and in 38 patients after CABG (p = 0.0018); its peak velocity increased after surgery only in the subgroup of patients with grafting of the RCA. In conclusion, these findings indicate that Doppler TEE may detect collateral flow in the inferior left ventricular wall, and that there are typical changes in collateral and physiologic flow after CABG. [Copyright &y& Elsevier]

The ratio of tricuspid peak early inflow velocity to peak early diastolic velocity of the lateral tricuspid annulus (the E/Ea ratio) measured by transthoracic echocardiography has been reported to correlate with right atrial (RA) pressure. In this study, the correlation between the E/Ea ratio and RA pressure was tested in 44 anesthetized, paralyzed, and mechanically ventilated patients by transesophageal echocardiography. Mean RA pressure and the following echocardiographic data were recorded simultaneously: tricuspid peak early inflow velocities by Doppler echocardiography, peak early diastolic velocity of the lateral tricuspid annulus by tissue Doppler imaging, and right ventricular and left ventricular end-diastolic areas. Linear regression did not indicate a correlation between the E/Ea ratio and RA pressure (r = −0.11, p = 0.48) or between the E/Ea ratio and the right or left ventricular end-diastolic area index; it revealed a weak correlation between RA pressure and the inspiratory plateau pressure and body mass index. In conclusion, the E/Ea ratio failed to predict RA pressure or planimetric indexes of ventricular preload in anesthetized, paralyzed, and mechanically ventilated patients. In these patients, RA pressure was largely influenced by extracardiac factors. [Copyright &y& Elsevier]