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Background: Determination of myocardial blood flow (MBF) with MRI is usually performed with dynamic contrast enhanced imaging (MBFDCE). MBF can also be determined from coronary sinus blood flow (MBFCS), which has the advantage of being a noncontrast technique. However, comparative studies of MBFDCE and MBFCS in large cohorts are lacking. Purpose: To compare MBFCS and MBFDCE in a large cohort. Study Type: Prospective, sequence‐comparison study. Population: 147 patients with type 2 diabetes mellitus (age: 56+/−12 years; 106 male; diabetes duration: 12.9+/−8.1 years), and 25 age‐matched controls. Field Strength/Sequences: 1.5 Tesla scanner. Saturation recovery sequence for MBFDCE vs. phase‐contrast gradient‐echo pulse sequence (free‐breathing) for MBFCS. Assessment: MBFDCE and MBFCS were determined at rest and during coronary dilatation achieved by administration of adenosine at 140 μg/kg/min. Myocardial perfusion reserve (MPR) was calculated as the stress/rest ratio of MBF values. Coronary sinus flow was determined twice in the same imaging session for repeatability assessment. Statistical Tests: Agreement between MBFDCE and MBFCS was assessed with Bland and Altman's technique. Repeatability was determined from single‐rater random intraclass and repeatability coefficients. Results: Rest and stress flows, including both MBFDCE and MBFCS values, ranged from 33 to 146 mL/min/100 g and 92 to 501 mL/min/100 g, respectively. Intraclass and repeatability coefficients for MBFCS were 0.95 (CI 0.90; 0.95) and 5 mL/min/100 g. In Bland–Altman analysis, mean bias at rest was –1.1 mL/min/100 g (CI −3.1; 0.9) with limits of agreement of −27 and 24.8 mL/min/100 g. Mean bias at stress was 6.3 mL/min/100 g (CI −1.1; 14.1) with limits of agreement of −86.9 and 99.9. Mean bias of MPR was 0.11 (CI: −0.02; 0.23) with limits of agreement of −1.43 and 1.64. Conclusion: MBF may be determined from coronary sinus blood flow, with acceptable bias, but relatively large limits of agreement, against the reference of MBFDCE. Level of Evidence: 1 Technical Efficacy Stage: 2 [ABSTRACT FROM AUTHOR]

Background: percutaneous coronary intervention for symptomatic patients with chronic stable angina improves coronary artery blood flow and hence the left ventricular perfusion. Transthoracic echocardiography that is simple, non-invasive and cost effective technique, can provide an efficient procedure for measuring coronary sinus blood flow. Objectives: to assess coronary sinus blood flow (CSBF) and global LV perfusion in the coronary sinus using 2 D and Doppler transthoracic echocardiography in patients with chronic stable angina before and after Percutaneous Coronary Intervention. Patients and methods: Ninety-two (92) patients with stable chronic coronary artery disease chosen after admission for diagnostic (and/or therapeutic) catheterization have been enrolled in the current study at the Department of Catheterization and Echocardiography in Baghdad teaching hospital. After admission for coronary angiography, 63 patients had positive coronary lesions and proceeded to percutaneous coronary intervention (PCI). Fifty 50 normal healthy adults with no coronary artery disease CAD or CAD risk factors cardiography was performed and CSBF, CSVTI, CSPG LV mass and LV perfusion were registered. Results: Basic parameters were the same between the two groups (P=0.05). Controls had significantly higher CSBF, global LV perfusion and lower LV mass than the cases group (3.04±0.7 mL/min/gm, 501.64±63.8 mL/min and 99.97±9.4gm/m2 in controls vs 2.11±1mL/min/gm, 223.15±55.7 mL/min and 195.74±68.6 gm/m2 in the cases group). The positive group also showed significant increase in CSBF 438.09±89.9 ml/min (p value less than 0.05) after successful PCI. The same applied for the global LV perfusion which increased to 2.537±1.06 mL/min/gm. Conclusion: This study revealed that the transthoracic echocardiographic measurement of the coronary sinus blood flow is a valuable tool to assess the results obtained by angiography and it can be used as a practical and reproducible method for observing the changes in cardiac perfusion before and after percutaneous coronary intervention in patients with chronic stable angina. [ABSTRACT FROM AUTHOR]

Reperfusion therapy for symptomatic patients with chronic stable angina enhances coronary artery flow and therefore the left ventricular perfusion. Transthoracic echocardiography, a simple, non-invasive and cost-effective technique, may provide a reliable method for measuring coronary sinus blood flow. To find the correlation of coronary sinus blood flow (CSBF) to left ventricular function using 2D and Doppler transthoracic echocardiography in patients with chronic stable angina who were eligible for percutaneous coronary intervention (PCI) before and after the procedure. Ninety-two (92) patients with stable chronic coronary artery disease chosen after admission for diagnostic (and/or therapeutic) catheterization have been enrolled in the current study at the Department of Catheterization and Echocardiography in Baghdad Teaching Hospital, they were listed as the cases group, after admission for PCI they were divided into the positive and the negative group based on their results. Standard 2D and Doppler echocardiography was performed and CSBF, CSVTI, CSPG, RWMSI, LV mass and LV perfusion were registered. Among the cases; the negative group had significantly higher global LV perfusion compared to the positive group (2.98±1.06 ml/min/g vs 1.02± 0.56± 0.56 ml/min/g) with P value less than 0.001. The correlation between CSBF and RWMSI severity was assessed before and after treatment, the positive group showed negative correlation (inverse; r = .238 and p = .34) that changed into no correlation after the treatment. The positive group also showed significant increase in CSBF 460.09±74.9 ml/min (p value less than 0.05) after successful PCI. The same applied for the global LV perfusion, which increased to 2.331±0.98 mL/min/gm. In conclusion, this study revealed that the coronary sinus blood flow measured by transthoracic echocardiography had strong correlation with results obtained by angiography. It can be used as a functional and reproducible method to track improvements in cardiac perfusion before and after percutaneous coronary intervention in patients with chronic stable angina. [ABSTRACT FROM AUTHOR]

Augmentation of coronary artery flow by surgical grafting increases coronary sinus blood flow (CSBF), which can be quantified on transesophageal echocardiography (TEE). However, transit time flowmetry (TTF) technology remains the most used intraoperative technique for coronary artery graft assessment. The purpose of the present pilot study was to evaluate the predictive value of TEE-based CSBF estimation for identifying favorable TTF graft measurements. Prospective observational study. Single university hospital. Forty patients undergoing triple vessel coronary artery bypass grafting. CSBF was assessed on TEE examination before and after revascularization, estimating the percentage increase in CSBF (∆CSBF). Postoperative TTF graft measurements were averaged to compute mean diastolic filling (DF) and pulsatility index (PI). Subjects were grouped based on favorable (PI ≤ 3, DF ≥ 50%) and unfavorable (PI > 3, DF < 50%) parameters. The group with PI ≤ 3 (n = 32) had significantly higher ∆CSBF compared with the group with PI > 3 (n = 8) (38.22% ± 12.05%, 13.75% ± 3.37%, p < 0.001). ∆CSBF was higher in the DF ≥ 50% group (n = 35) (36.40 ± 12.99) in contrast to DF < 50% group (n = 5) (11.80 ± 2.59%). A strong negative and significantly positive correlation was observed between ∆CSBF with PI, DF (r = –0.903, 0.571, respectively, p < 0.001). A ∆CSBF ≥15.5% was found to predict a mean PI ≤ 3 and DF ≥ 50% with sensitivity and specificity of 100% and 62.5% for PI and 100% and 100% for DF. A ∆CSBF ≥19% demonstrated a sensitivity and specificity of 100% and 100%, 100% and 91.4% for prediction of PI ≤ 3 and DF ≥ 50%, respectively. TEE-based demonstration of an augmented CSBF can ensure favorable TTF graft parameters, guiding the adequacy of surgical revascularization. [ABSTRACT FROM AUTHOR]

Background: Transthoracic echocardiography (TTE) has been used to assess coronary sinus blood flow (CSBF), which reflects total coronary arterial blood flow. Successful angioplasty is expected to improve coronary arterial blood flow. Changes in CSBF after percutaneous coronary intervention (PCI), as assessed by TTE, have not been systematically evaluated.Hypothesis: TTE can be utilized to reflect increased CSBF after a successful, clinically indicated PCI.Methods: The study cohort included 31 patients (18 females, 62 ± 11 years old) referred for diagnostic cardiac catheterization for suspected coronary artery disease and possible PCI, when clinically indicated. All performed PCIs were successful, with good angiographic outcome. CSBF per cardiac cycle (mL/beat) was measured using transthoracic two-dimensional and Doppler flow imaging as the product of coronary sinus (CS) area and CS flow time-velocity integral. CSBF per minute (mL/min) was calculated as the product of heart rate and CSBF per cardiac cycle. In each patient, CSBF was assessed prospectively, before and after cardiac catheterization with and without clinically indicated PCI. Within- and between-group differences in CSBF before and after PCI were assessed using repeated measures analysis of variance.Results: Technically adequate CSBF measurements were obtained in 24 patients (77%). In patients who did not undergo PCI, there was no significant change in CSBF (278.1 ± 344.1 versus 342.7 ± 248.5, p = 0.36). By contrast, among patients who underwent PCI, CSBF increased significantly (254.3 ± 194.7 versus 618.3 ± 358.5 mL/min, p < 0.01, p-interaction = 0.03). Other hemodynamic and echocardiographic parameters did not change significantly before and after cardiac catheterization in either treatment group.Conclusions: Transthoracic echocardiographic assessment can be employed to document CSBF changes after angioplasty. Future studies are needed to explore the clinical utility of this noninvasive metric. [ABSTRACT FROM AUTHOR]

BackgroundRecent studies using stress‐rest perfusion cardiovascular magnetic resonance (CMR) demonstrated a close correlation between myocardial ischemia and reduced fractional flow reserve (FFR). However, its diagnostic concordance may be reduced in patients with multivessel disease. We sought to evaluate the concordance of adenosine stress‐rest perfusion CMR for predicting reduced FFR, and to determine the additive value of measuring global coronary flow reserve (CFR) in the coronary sinus in multivessel disease. Methods and ResultsNinety‐six patients with angiographic luminal narrowing >50% underwent comprehensive CMR study and FFR measurements in 139 coronary vessels. FFR

Aims and Objectives: Physiologically coronary sinus (CS) drains the left coronary artery (LCA) territory. Stenosis of the branches of LCA may decrease the coronary sinus blood flow (CSBF). Any intervention that aims at restoring the flow of the stenosed vessel increases coronary artery flow that should consequently increase the CSBF. Hence, this study was undertaken to assess the CSBF before and after each branch of LCA to determine the adequacy of surgical revascularization in patients undergoing elective off pump coronary artery bypass grafting (OPCAB) using transesophageal echocardiography (TEE). Materials and Methods: Thirty consecutive patients scheduled for elective OPCAB were enrolled. CSBF was assessed before and after each branch of LCA revascularization using TEE. Left internal mammary artery (LIMA) Doppler was also obtained post LIMA to left anterior descending (LAD) grafting. Results: Hemodynamic and echocardiographic variables were compared by means of Student′s t-test for paired data before and after revascularization. The CSBF per beat (1.28 ± 0.71), CSBF per minute (92.59 ± 59.32) and total velocity time integral (VTI) (8.93 ± 4.29) before LAD grafting showed statistically significant increase to CSBF per beat (1.70 ± 0.89), CSBF per minute (130.72 ± 74.22) and total VTI (11.96 ± 5.68) after LAD revascularization. The CSBF per beat (1.67 ± 1.03), CSBF per minute (131.91 ± 86.59) and total VTI (11.00 ± 5.53) before obtuse marginal (OM) grafting showed statistically significant increase to CSBF per beat (1.91 ± 1.03), CSBF per min (155.20 ± 88.70) and total VTI (12.09 ± 5.43) after OM revascularization. In 9 patients, color flow Doppler of LIMA could be demonstrated which showed diastolic predominant blood flow after LIMA to LAD grafting. Conclusion: Demonstration of CSBF was simple and monitoring the trend of CSBF values before and after each graft of LCA territory will guide to determine the adequacy of surgical revascularization.

Objective: Epidural anesthesia is a central neuraxial block technique with many applications. It is a versatile anesthetic technique, with applications in surgery, obstetrics and pain control. Its versatility means it can be used as an anesthetic, as an analgesic adjuvant to general anesthesia, and for postoperative analgesia. Off pump coronary artery bypass (OPCAB) surgery triggers a systemic stress response as seen in coronary artery bypass grafting (CABG). Thoracic epidural anesthesia (TEA), combined with general anesthesia (GA) attenuates the stress response to CABG. There is Reduction in levels of Plasma epinephrine, Cortisol and catecholamine surge, tumor necrosis factor-Alpha( TNF ά), interleukin-6 and leucocyte count. Design: A prospective randomised non blind study. Setting: A clinical study in a multi specialty hospital. Participants: Eighty six patients. Material and Methods/intervention: The study was approved by hospital research ethics committee and written informed consent was obtained from all patients. Patients were randomised to receive either GA plus epidural (study group) or GA only (control group). Inclusion Criteria (for participants) were -Age ≥ 70 years, Patient posted for OPCAB surgery, and patient with comorbidities (diabetes mellitus, chronic obstructive pulmonary disease, cerebrovascular disease, peripheral vascular disease, renal dysfunction). Serum concentration of Interlukin: - 6, TNF ά, cortisol, Troponin - I, CK-MB, and HsCRP (highly sensitive C reactive protein), was compared for both the group and venous blood samples were collected and compared just after induction, at day 2, and day 5 postoperatively. Time to mobilization, extubation, total intensive care unit stay and hospital stay were noted and compared. Independent t test was used for statistical analysis. Primary Outcomes: Postoperative complications, total intensive care unit stay and hospital stay. Secondary Outcome: Stress response. Result: Study group showed decreased Interlukin - 6 at day 2, TNF ά at day 2 and 5,troponin I at day 5, and decreased total hospital stay ( p < 0.05). Conclusion: Thoracic epidural anesthesia decreases stress and inflammatory response to surgery and decreases hospital stay. However a large multicentre study may be needed to confirm it.

Cardiac hydatidosis is rare presentation of body hydatidosis. Incidence of cardiac involvements range from 5% to 5% of patients with hydatid disease. Most common site of hydatid cyst in heart is interventricular septum and left ventricular free wall. Right ventricular free wall involvement by cyst that ruptured to pericardial cavity is very rare presentation of hydatid cyst. Cardiac involvement may have serious consequences such as rupture to blood steam or pericardial cavity. Both the disease and its surgical treatment carry a high complication rate, including rupture leading to cardiac tamponade, anaphylaxis and also death. In the present report, a 43-year-old man with constrictive pericarditis secondary to a pericardial hydatid cyst is described.

Background: Standard methods for the measurement of myocardial perfusion are invasive and require cardiac catheterization or the use of radioisotope dyes. The coronary sinus blood flow (CSBF) is an appropriate criterion for the efficacy of myocardial perfusion. This study sought to measure CSBF via transthoracic echocardiography (TTE) in patients with acute myocardial infarction (AMI) and to assess its relation with left ventricular ejection fraction (LVEF), wall motion scoring index (WMSI), and in-hospital mortality.Methods: This case-control study evaluated 20 patients (pts) with anterior AMI and 20 healthy individuals as controls over a 6-month period (in 2005) in Madani Heart Center in Tabriz (Iran). All the patients received the same drugs for AMI treatment (e.g. fibrinolytic). CSBF and WMSI, having been obtained via TTE, were compared between the two groups. Results: Baseline variables were similar between the two groups (P>0.05). CSBF in the AMI group was 287.8±128 ml/min and in the control group was 415±127 ml/min (P=0.001). There was a significant correlation between CSBF and LVEF (r=0.52, P=0.01), between CSBF and WMSI (r=-0.77, P=0.0001), and between CSBF and in-hospital mortality (r=0.58, P=0.03). Conclusion: Our study demonstrated a good correlation between CSBF measured with 2D-doppler TTE and LVEF, WMSI, and in-hospital mortality.

Background: Standard methods for the measurement of myocardial perfusion are invasive and require cardiac catheterization or the use of radioisotope dyes. The coronary sinus blood flow (CSBF) is an appropriate criterion for the efficacy of myocardial perfusion. This study sought to measure CSBF via transthoracic echocardiography (TTE) in patients with acute myocardial infarction (AMI) and to assess its relation with left ventricular ejection fraction (LVEF), wall motion scoring index (WMSI), and in-hospital mortality. Methods: This case-control study evaluated 20 patients (pts) with anterior AMI and 20 healthy individuals as controls over a 6-month period (in 2005) in Madani Heart Center in Tabriz (Iran). All the patients received the same drugs for AMI treatment (e.g. fibrinolytic). CSBF and WMSI, having been obtained via TTE, were compared between the two groups. Results: Baseline variables were similar between the two groups (P>0.05). CSBF in the AMI group was 287.8±128 ml/min and in the control group was 415±127 ml/min (P=0.001). There was a significant correlation between CSBF and LVEF (r=0.52, P=0.01), between CSBF and WMSI (r=-0.77, P=0.0001), and between CSBF and in-hospital mortality (r=0.58, P=0.03). Conclusion: Our study demonstrated a good correlation between CSBF measured with 2D-doppler TTE and LVEF, WMSI, and in-hospital mortality.

To determine the relative effects of nifedipine and nicardipine on left ventricular inotropy we directly injected into the left main coronary artery, in 12 patients with coronary artery disease, 20 min apart and in random order, 0.2 mg of each drug, which had previously been shown to increase coronary sinus blood flow equally. All variables were recorded at time (min), 1 through 5 and 7.5 and 10 min after injection., Coronary sinus blood flow was increased by both drugs to the same extent (54% vs 56%)., Peak (+) and peak (-) dP/dt, and (dP/dt)/DP40 were affected by both drugs after 1 min, but by nifedipine to a significantly larger extent ( P < 0.001, P < 0.001 and P < 0.005 respectively)., Left ventricular end-diastolic pressure was also increased by both drugs, but again was more pronounced after nifedipine (79% vs 30%, P < 0.001)., Left ventricular systolic pressure, mean aortic pressure and pulmonary artery pressure were not affected by nicardipine in contrast to nifedipine., At doses that increased coronary sinus blood flow to a similar extent, nicardipine, in contrast to nifedipine, showed little effect on left ventricular inotropy. [ABSTRACT FROM AUTHOR]

By measuring the coronary sinus blood flow using the thermodilution technique the influence of “thermodilution catheter” withdrawal from the great cardiac vein to the ostium of the coronary sinus was investigated in 41 patients. In addition, the influence of normal and forced respiration on coronary sinus blood flow was measured in 16 of the patients. Mean great cardiac vein flow was measured to 54±25 ml·min−1. Catheter withdrawal revealed coronary sinus blood flows of 80±32, 103±35, 145±39 and 213±61 ml·min−1 when the catheter was moved by steps of 1 cm towards the coronary sinus ostium. The coronary sinus blood flow changed between 116±34 ml·min−1 and 128±41 ml·min−1 on expiration or inspiration during normal respiration, respectively, when the catheter was placed in a mid-coronary sinus position. Forced respiration changed the coronary sinus blood flow from 98±41 ml·min−1 during expiration to 196±76 ml·min−1 during inspiration.The data show that coronary sinus blood flow changes from 23 to 68 ml·min−1 per cm catheter movement, the nearer the ostium the greater the change. Therefore comparison of coronary sinus blood flow between groups of patients would be a comparison between different catheter positions. Normal respiration moves, as judged by the coronary sinus blood flow, the thermodilution catheter by less than 0.5 cm while forced respiration moves the catheter up to 2 cm within the coronary sinus. [ABSTRACT FROM PUBLISHER]

In hydraulic non-occlusive models, mixing effects were studied with slug-injection and constant-infusion techniques. Measurements were accomplished by means of catheters specially constructed with thermistors. Constant-rate infusion of 5 ml/min of saline at room temperature showed homogeneity of mixing. Good correlation ( r=0.936) was found between metered flow ranging from 50-450 ml/min and reciprocal temperature changes. In anesthetized open chest dogs reciprocal temperature changes during constant-infusion thermodilution was compared with coronary sinus flow metered by graduated cylinder and stop-watch. For this purpose all the coronary sinus blood was directed through a tubing system with a Y-connector into the jugular vein. In the range of 50-450 ml/min the metered coronary sinus blood flow and the reciprocal of the observed changes in temperature showed a linear correlation ( r=0.949). The reproducibility of the thermodilution method is fairly good. Therefore it is believed that this technique will allow accurate measurement of coronary sinus blood flow. [ABSTRACT FROM AUTHOR]

In order to establish whether coronary flow reserve (CFR) can be measured by transthroracic echocardiography (TTE) with pulse wave Doppler echocardiography, 14 patients with coronary artery disease (CAD) and 12 normal subjects were studied. Coronary sinus blood flow was measured at rest and 2 minutes after intravenous injection of 0.56 mg/kg dipyridamole (DP). CFR was calculated as the DP to rest flow ratio. Patients with CAD were found to have significantly decreased CFR when compared to normal subjects. These findings suggest that TTE may be useful in diagnosing CAD. [ABSTRACT FROM AUTHOR]