Intraoperative evaluation of pathophysiological role of coronary slosh phenomenon

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With increasing severity of cardiac diseases for cardiac operation, intra-aortic balloon pumping has been frequently used for these patients. Evaluation of the effect of intraaortic balloon pumping on the phasic blood velocity waveform into myocardium with coronary artery stenosis revealed followings : In the presence of severe coronary artery stenosis, intra-aortic balloon pumping failed to increase the diastolic inflow to the myocardium and did not enhance the systolic retrograde flow from the myocardium to the extramural coronary artery. Thus, the major effect of intra-aortic balloon pumping on the ischemic heart with severe coronary stenosis may be achieved by reducing oxygen demand by the systolic unloading. Since there are increasing number of studies indicating that the vascular endothelial function is disturbed in patients with coronary risk factors, including hypertension and hyperlipidemia, we have evaluated the influence of endothelial dysfunction on the intramyocardial circulation and the effect of intra-aortic ballon pumping on it. With intracoronary administration of N^<omega>-nitro-L arginine (L-NNA,2 mumol/min) in dogs, the effects of intra-aortic balloon pumping on the intramyocardial vessels were significantly attenuated. It is also shown that endothelium-derived nitric oxide plays roles in intramyocardial regulation of vascular diameter and its pulsation.