Aragam J R, Main J, Guerrero J L, Vlahakes G J, Southern J F, Adams M S, Weyman A E, Levine R A
Noninvasive Cardiac Laboratory, Massachusetts General Hospital, Boston 02114.
J Am Coll Cardiol. 1993 Feb;21(2):478-87. doi: 10.1016/0735-1097(93)90692-t.
We addressed the hypothesis that blood flow could be imaged by Doppler color flow mapping of the coronary arteries and characteristic patterns described in normal and diseased vessels.
Echocardiographic imaging of the epicardial coronary arteries has been suggested as a useful adjunct to their intraoperative evaluation. Addition of Doppler color flow mapping could potentially enhance this evaluation by displaying the flow disturbance produced by anatomic lesions whose physiologic significance may otherwise be uncertain. In experimental models, such displays could also potentially provide insights into the pathophysiology of coronary blood flow and stenosis.
Epicardial coronary arteries were examined with a high resolution 7-MHz linear phased-array transducer both in vivo and in vitro. 1) The coronary arteries were studied in the beating hearts of 10 open chest dogs in which experimental stenoses were also created; the maximal extent of the arterial tree in which flow could be seen in the most ideal setting was also examined in four additional excised perfused canine hearts. 2) Six excised human coronary arteries were perfused in a pulsatile manner to determine whether abnormal flow patterns could be prospectively identified and subsequently correlated with pathologic evidence of stenosis.
All normal coronary artery segments studied showed homogeneous flow without evidence of flow disturbance. In the excised heart, flow could be visualized to the distal extent of the epicardial vessels; in the open chest model, visualization of the proximal 5 to 6 cm was comparable, although surrounding structures limited access to the terminal portions of the vessels. The stenotic lesions created in the canine hearts (n = 9) showed recognizable alterations in the flow pattern: localized aliasing, proximal blood flow acceleration, distal flow disturbance and recirculatory flow. In the excised human arteries, these features identified 12 lesions, all of which corresponded to areas of > or = 50% lumen narrowing by pathologic examination.
Blood flow in the epicardial coronary arteries can be imaged by Doppler color flow mapping and characteristic flow patterns described in normal and diseased vessels.
我们探讨了通过冠状动脉多普勒彩色血流图成像以及描述正常和病变血管特征模式来成像血流的假设。
心外膜冠状动脉的超声心动图成像已被认为是术中评估的有用辅助手段。添加多普勒彩色血流图可能通过显示解剖病变产生的血流紊乱来增强这种评估，而这些病变的生理意义否则可能不确定。在实验模型中，这种显示还可能为冠状动脉血流和狭窄的病理生理学提供见解。
使用高分辨率7兆赫线性相控阵换能器在体内和体外检查心外膜冠状动脉。1）在10只开胸犬的跳动心脏中研究冠状动脉，其中还制造了实验性狭窄；另外在4只切除并灌注的犬心脏中检查了在最理想情况下能看到血流的动脉树的最大范围。2）以搏动方式灌注6条切除的人类冠状动脉，以确定是否能前瞻性地识别异常血流模式，并随后将其与狭窄的病理证据相关联。
所有研究的正常冠状动脉节段均显示血流均匀，无血流紊乱迹象。在切除的心脏中，可在心外膜血管的远端看到血流；在开胸模型中，近端5至6厘米的可视性相当，尽管周围结构限制了对血管末端部分的观察。在犬心脏中制造的狭窄病变（n = 9）显示出血流模式的可识别改变：局部混叠、近端血流加速、远端血流紊乱和再循环血流。在切除的人类动脉中，这些特征识别出12个病变，所有这些病变经病理检查均对应于管腔狭窄≥50%的区域。
心外膜冠状动脉的血流可通过多普勒彩色血流图成像以及描述正常和病变血管的特征血流模式来成像。
