A 52-year-old patient underwent percutaneous balloon
pericardiotomy because of rapid fluid accumulation. During the
procedure, we calculated the amount of blood flow to the nondiseased
left anterior descending coronary artery while pericardial pressure was
gradually increased by the infusion of warmed normal saline solution.
Coronary vasodilator reserve was assessed by intracoronary adenosine.
With increasing pericardial pressure, there was a continuous decline in
coronary blood flow, due to an increase in coronary vascular
resistance, and an unaffected hyperemic response throughout. The
maximal hyperemic flow was far less under increased pericardial
pressure than at normal pressure, which implies an augmented
susceptibility to myocardial