Effects of pressure-controlled intermittent coronary sinus occlusion on regional ischemic myocardial function

Möhl, Werner; Punzengruber, Christian; Moser, M.; Kenner, Thomas; Heimisch, W.; Haendchen, Roberto V.; Meerbaum, Samuel; Maurer, Gerald; Corday, Eliot

doi:10.1016/s0735-1097(85)80437-x

Cited by 48 publications

(12 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our method was used to study the possible favorable mechanism of intermittent coronary sinus occlusion (43). During periodic occlusion of the coronary sinus the arterio-venous density gradient reversed, thus indicating washout of interstitial fluid from the myocardium (30,31,32,43).…”

Section: Arterio-venous Difference and Lymph Productionmentioning

confidence: 99%

The measurement of blood density and its meaning

Kenner

1989

Basic Res Cardiol

150

View full text Add to dashboard Cite

Density is defined as mass per unit volume. The classical technique to measure the density of fluids consists of a determination of mass and volume. Blood density is proportional to hematocrit or, more exactly, to the total protein concentration of blood; only to a minor extent is blood density influenced by other plasma solutes. Since the introduction of the mechanical oscillator technique for the continuous recording of fluid density a sizeable amount of experience has accumulated. This review summarizes recent work performed with this technique. It appears that the scientific interest in a variable like blood density depends on the availability of a suitable and simple method. Until the oscillator technique was available the measurement of density was too complicated or too inaccurate for routine laboratory use. A further new technique permits us to determine fluid densities by measuring sound velocity transmission. The density dilution method can be used for the determination of distribution volumes, of flow through organs, and of the cardiac output. The influence of temperature and of certain artifacts like acceleration forces in the density measuring device have to be considered any may be used for additional diagnostic purposes like determination of erythrocyte sedimentation velocity. The new technique opens a reasonable simple way to study fluid shift between interstitial space and capillaries. The arterio-venous density gradient in an organ depends on the lymph production. The injection of a hypertonic solution leads to an osmotic fluid shift from the extravascular space towards the blood. This fluid shift can be recognized by a reduction of the blood density. A simple model for the description of this reaction is presented.

show abstract

Section: Arterio-venous Difference and Lymph Productionmentioning

confidence: 99%

The measurement of blood density and its meaning

Kenner

1989

Basic Res Cardiol

150

View full text Add to dashboard Cite

show abstract

“…After the results of studies on coronary sinus blood density during ICSO treatment, Mohl et al 18 suggested indeed that the rapid reduction of coronary sinus pressure after the prolonged phase of plateau may induce a sort of aspirating effect on fluids and toxic metabolites accumulated in the ischaemic segment. In this way, PICSO would not just allow, but would improve the systolic cardiac venous drainage.…”

Section: Techniques For Csimentioning

confidence: 99%

Reconsidering the back door approach by targeting the coronary sinus in ischaemic heart disease

Maria

Kassimis

Raina

et al. 2016

Heart

View full text Add to dashboard Cite

Coronary sinus interventions (CSI) are a class of invasive techniques (surgical and percutaneous) originally proposed in the first half of the 20th century, aiming to treat ischaemic heart disease by acting on the venous coronary system. Three main classes of CSI have been proposed and tested: (1) retroperfusion technique, (2) retroinfusion technique and (3) coronary sinus occlusion techniques. They all share the principle that a controlled increased pressure within the coronary sinus may promote a retrograde perfusion of the ischaemic myocardium with consequent cardioprotection. Development of arterial treatments including coronary aortic bypass grafting and then percutaneous coronary intervention deflected interest from interventions on the coronary venous system. However, CSI may still have a possible niche role today in specific and selected clinical contexts in which existing therapies are insufficient. In this review paper, we aim to revise the rationale for CSI, describing the details and the evidence collected so far about these techniques and to provide insights about the main clinical scenarios in which these strategies may find a contemporary application in combination or as an alternative to existing approaches.

show abstract

“…Therefore, redistribution of venous flow together with periodic washout of metabolites, rather than additional arterial infusion and perfusion, is responsible for myocardial salvage [50,54,55].…”

Section: The Salvage Potential Of Picsomentioning

confidence: 99%

PICSO: from myocardial salvage to tissue regeneration

Möhl

Gangl

Jusić

et al. 2015

Cardiovascular Revascularization Medicine

Self Cite

View full text Add to dashboard Cite

Despite advances in primary percutaneous interventions (PPCI), management of microvascular obstructions in reperfused myocardial tissue remains challenging and is a high-risk procedure. This has led to renewed interest in the coronary venous system as an alternative route of access to the myocardium. This article reviews historical data describing therapeutic options via cardiac veins as well as discussing the clinical potential and limitations of a catheter intervention: pressure controlled intermittent coronary sinus occlusion (PICSO). Collected experimental and clinical information suggest that PICSO also offers the potential for tissue regeneration beyond myocardial salvage. A meta-analysis of observer controlled pICSO application in animal studies showed a dose dependent reduction in infarct size of 29.3% (p < 0.001). Additionally, a 4-fold increase of hemeoxygenase-1 gene expression (p < 0.001) in the center of infarction and a 2.5 fold increase of vascular endothelial growth factor (VEGF) (p < 0.002) in border zones suggest that molecular pathways are initiating structural maintenance. Early clinical evidence confirmed significant salvage and event free survival in patients with acute myocardial infarction and risk reduction for event free survival 5 years after the acute event (p < 0.0001). This experimental and clinical evidence was recently corroborated using modern PICSO technology in PPCI showing a significant reduction of infarct size, when compared to matched controls (p < 0.04). PICSO enhances redistribution of flow towards deprived zones, clearing microvascular obstruction and leading to myocardial protection. Beyond salvage, augmentation of molecular regenerative networks suggests a second mechanism of PICSO involving the activation of vascular cells in cardiac veins, thus enhancing structural integrity and recovery.

show abstract

Effects of pressure-controlled intermittent coronary sinus occlusion on regional ischemic myocardial function

Cited by 48 publications

References 11 publications

The measurement of blood density and its meaning

The measurement of blood density and its meaning

Reconsidering the back door approach by targeting the coronary sinus in ischaemic heart disease

PICSO: from myocardial salvage to tissue regeneration

Contact Info

Product

Resources

About