Abstract
M YOCARDIAL revascularization with an aortocoronary bypass graft or angioplasty is an effective means of reducing the symptoms of myocardial ischemia and normalizing previously positive tests of provokable myocardial ischemia. The effect of these procedures on coronary hemodynamics and their efficacy in restoring normal myocardial perfusion is less clear. Unlike studies performed in normal animals, the effects of the coronary revascularization in patients must be studied in the setting of coronary atherosclerosis, a pathologic process that is complex and variable in severity and distribution. Additionally, techniques for studying the effects of revascularization in humans (quantitation of coronary arterial geometry, measurement of coronary blood flow, and determination of the flow reserve capacity of revascularized arteries) suffer serious deficiencies. As a result, studies of the effects of revascularization procedures on coronary blood flow and coronary reserve should be interpreted cautiously, taking into account their many methodologic limitations. The purpose of this article is to define the limitations of current techniques for measuring coronary blood flow and flow reserve following revascularization, to review prior studies of the effects of coronary bypass surgery or angioplasty on coronary blood flow and flow reserve, and to elucidate what these studies tell us about the coronary circulation of humans.
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