Abstract
Objective Differences in opinion exist on the influence of collateral flow in the presence of a flow-limiting stenosis. It is assumed that myocardial flow exceeds coronary flow following from collateral contribution. However, since the microvascular resistance of the vascular bed is dependent on distal pressure, collateral flow may be overestimated. The study aims to assess the level of collateral flow as a function of distal pressure and to compare the pressure based measured collateral flow with collateral flow as assessed by injection of fluorescent microspheres. Methods In anesthetized dogs, a guide wire with both a pressure and a Doppler velocity sensor was introduced in the left circumflex artery (LCX). Microspheres were injected to determine perfusion territories in the LCX and left anterior descending artery (LAD). Microspheres were infused for LAD to LCX flow measurement. After surgery, hearts were analyzed using our previously developed imaging cryomicrotome. Results Collateral flow as measured by microspheres crossing from the LAD to the LCX was inversely related to distal pressure. Pressure-derived measurement of collateral flow appears higher than microsphere based measurements. Conclusion Pressure-based collateral flow measurements may yield incorrect high estimates of collateral flow in patients. This study is supported in part by Netherlands Heart Foundation, grant # 2006B226.
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