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Coronary pressure measurement has emerged as a major step forward in the invasive assessment of coronary artery disease. This was made possible on one hand by technical progress in developing pressure-monitoring guide wires, and on the other hand to a theoretical innovation, the concept of coronary pressure-derived fractional flow reserve which closely relates distal coronary pressure to myocardial flow. In the catheterization laboratory, fractional flow reserve enables an "on-the-spot" quantification of the extent to which a given epicardial stenosis contributes to reversible myocardial ischemia and the decision whether revascularization of the stenosis is warranted or not. Moreover, this new approach has proven to be valuable in many complex diagnostic situations encountered in the catheterization laboratory. In addition, pressure-derived fractional flow reserve appears to be a useful index in monitoring and guiding coronary intervention, including stent deployment.In this text, the theoretical and physiological background of this approach is systematically reviewed and the most advanced clinical applications are illustrated, both at diagnostic and interventional catheterization. Practical set-up of coronary pressure measurement, including tips, tricks, and potential pitfalls are particularly emphasized in this new edition.
2 407 kr
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A little bit more than two years after the first edition, we are pleased to publish the second edition of this book. More than half of the chapters have been remodeled and completed as the result of technical improvements and recently acquired clinical data. During these two years, the number of coronary pressure measurements performed worldwide both during diagnostic and interventional procedures has increased almost exponentially. Most of the initial problems associated with this new approach have been overcome. Many colleagues have explored new research avenues and in many catheterization laboratories the method has matured from a research toy to a clinical tool. Classical indications such as the intermediate stenosis and guidance of PTCA or stent implantation, have been largely extended and coronary pressure measurement has proven to be useful in multi vessel disease, diffuse disease, long and serial stenosis, after myocardial infarction, and in many other diagnostic and interventional situations encountered in the catheterization laboratory. Quite unexpectedly, this approach has also enforced the ties with our surgical colleagues in the selection of patients suitable for minimal invasive surgery or hybride revascularization. Also in mild and intermediate left main disease, there is a role for coronary pressure measurement in the process of decision making. We would like to express our gratitude to all those many colleagues who trusted and applied this new approach for the benefit of their patients. Aalst, Eindhoven, Bernard De Bruyne. Nico H. J. Pijls. March, 2000. Table of Contents (overview) 1 1.