Brief report
Intraoperative demonstration of coronary collateral flow using myocardial contrast two-dimensional echocardiography

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Abstract

The extent of coronary collateral vessels and their significance are controversial issues.1 The controversy regarding collaterals in man is related, to a large extent, to the lack of an appropriate method to assess collateral function in vivo. The most frequently used technique of assessing collateral blood vessels is coronary angiography. This technique, however, can only detect vessels >100 to 200 μ in diameter.1 It has been shown in animals, particularly dogs, that most of the collateral vessels are <100 μ in diameter.1 Furthermore, the angiographic assessment of collateral vessels is unrelated to the functional capacity of these channels.1

Myocardial contrast echocardiography is a new technique capable of demonstrating myocardial perfusion in humans.2 This technique uses the intracoronary or intraaortic injection of microbubbles of air. The size of these microbubbles is similar to that of red blood cells, as is their intravascular rheology.3 The appearance of these microbubbles within regions of the myocardium remote from the site of injection should, therefore, reflect collateral flow. This technique has been shown to demonstrate collateral flow in dogs.4

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This study was supported in part by a grant-in-aid from the Virginia Affiliate of the American Heart Association, Glen Alien, Virginia, and a grant-in-aid from the American Heart Association, Dallas, Texas.

1

Dr. Matthew was the recipient of a Ford Foundation Fellowship.

2

Dr. Keller was the recipient of fellowship training grant F32-HL-07502 from the National Institutes of Health, Bethesda, Maryland.

3

Dr. Kaul is the recipient of the Clinical Investigator Award (K08-HL01833) and the FIRST Award (R29-HL-38345) from the National Institutes of Health.

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