Cardiac hemodynamics, coronary circulation and interventional cardiology

Microcirculation is the functional end of the coronary circulation and it plays a key role in the regulation of coronary blood flow, both on the local and global scales. A good understanding of its function under physiological and pathophysiological conditions is crucial but, because of its micro-scale, access to this part of the coronary circulation is extremely difficult and requires a considerable amount of innovation and new technologies. Dynamics of the coronary circulation provide the true vehicle by which blood supply reaches the myocardium- coronary vasculature is only the conducting component of that vehicle. It is highly unlikely that the pulsatile nature of the flow, the capacitance of the conducting vessels and the constant pounding of coronary vasculature by surrounding tissue are not part of the design, regulation, and function of the coronary circulation. Interventions, whether to assess or to correct coronary stenosis, continue to be the main clinical avenue to dealing with coronary heart disease. Clinical decisions rely heavily on the ability to determine the true morphology of an occlusive lesion, to predict the future course of that lesion and to assess the functional toll on coronary blood supply which it will inflict at each stage.