Experimental Attempts to Increase the Blood Supply to the Dog's Heart by Means of Coronary Sinus Occlusion

Gross, Louis J.; Blum, Lester; Silverman, Gerald

doi:10.1084/jem.65.1.91

Cited by 86 publications

(18 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, we did not find any histological evidence of myocardial injury or inflammatory process in the microcirculation in response to ligation of the LAD vein. Previously, Gross et al (15) have shown that prior venous ligation reduces the mortality rate from subsequent coronary ligation.…”

Section: Discussionmentioning

confidence: 98%

“…The method was abandoned, however, because of the high mortality rate from the edema and hemorrhage in the postcapillary venules that resulted from the elevated pressure (6,8,12,26). To remedy these difficulties, we propose to avoid raising the pressure in the left anterior descending (LAD) vein from venous (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) to arterial values (100 -120 mmHg) in a single step. Instead, we occlude the great cardiac vein for a period of 2 wk to allow the LAD vein and its branches to adapt to the intermediate pressures.…”

mentioning

confidence: 99%

See 1 more Smart Citation

A novel strategy for increasing wall thickness of coronary venules prior to retroperfusion

Choy

Kassab²

2006

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

Choy, Jenny Susana, and Ghassan S. Kassab. A novel strategy for increasing wall thickness of coronary venules prior to retroperfusion. Am J Physiol Heart Circ Physiol 291: H972-H978, 2006. First published April 7, 2006 doi:10.1152/ajpheart.00235.2006.-The sudden exposure of veins to arterial pressures during coronary venous retroperfusion may cause rupture of small venules. Our rationale is to first occlude the coronary vein, which will cause an increase in pressure intermediate to arterial and venous values, and hence lead to remodeling and increased wall thickness of the veins prior to retroperfusion. To accomplish this objective, five pigs were subjected to left anterior descending (LAD) vein ligation while six pigs served as sham. Myocardial tissue samples were obtained from the area adjacent to the LAD vein at four transmural locations of the left ventricular free wall: epicardial surface, subepicardium, midmyocardium, and endocardium. Arterioles and venules from the experimental and sham control groups were photographed, and the following measurements were made: inner and outer circumferences, inner and outer areas, major and minor diameters, and intima-media thickness. Each vessel was categorized in four different orders according to lumen diameter. Our results show that intima-media thickness was larger in the experimental group in all four regions of the heart and in all four orders of the vessels, although venules from the epicardial region showed the largest increase in thickness. The intima-media thicknessto-radius ratio was also larger in the experimental group and decreased from epicardial to endocardial region of the heart and from order 1 to order 4 of the vessels. The present study provides a rationale for the development of coronary retroperfusion strategy that avoids vessel rupture and hemorrhage in the postcapillary venules. pressure overload; arterialization; rupture stress; remodeling; ligation BECAUSE THE CORONARY VEINS rarely develop arteriosclerosis (8,23,24), it is desirable to use these vessels as conduits for revascularization. The possibility of coronary retroperfusion was first suggested by Pratt (27) in 1898, when he was able to sustain the mechanical function of a cat's heart by delivering oxygenated blood through the coronary sinus. Almost 50 years after this seminal study, the first attempts at arterialization of the coronary sinus were made by Roberts et al. (30) and Beck et al. (5), independently. In 1943, Roberts et al. (30) suggested the use of coronary veins as conduits to deliver oxygenated blood in a retrograde manner in animal studies. In 1948, Beck and colleagues (5) performed the coronary retroperfusion procedure in humans. The method was abandoned, however, because of the high mortality rate from the edema and hemorrhage in the postcapillary venules that resulted from the elevated pressure (6,8,12,26). To remedy these difficulties, we propose to avoid raising the pressure in the left anterior descending (LAD) vein from venous (10 -20 mmHg) to arterial values (100 ...

show abstract

Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

A novel strategy for increasing wall thickness of coronary venules prior to retroperfusion

Choy

Kassab²

2006

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

show abstract

“…3 Had increased venous pressure somehow improved myocardial perfusion? Could the same effect be achieved by ligating the coronary sinus?…”

mentioning

confidence: 99%

“…3 Partial ligation protected dogs against subsequent occlusion of their coronary arteries. 2,3 The exact physiological mechanism was never clear. Beck speculated that venous congestion allowed the myocardium to extract more oxygen or minimized the oxygen differentials that produced fibrillating currents.…”

mentioning

confidence: 99%

The Puzzle of Positive Results — Myocardial Revascularization

Jones¹

2015

N Engl J Med

View full text Add to dashboard Cite

“…We showed many years ago that occlusion of the coronary sinus increases venous pressure to 50% to 70% of left ventricular systolic pressure but the diastolic pressure is identical to left ventricular diastolic pressure, presumably transmitted through Thebesian veins or from the myocardium or both. 8 Interventions through the coronary veins to treat coronary artery disease was first suggested by Pratt over 100 years ago but were not actively investigated until the 1937 when Gross et al 9 demonstrated that retrograde flow into the ventricles after ligation of the coronary sinus in an experimental infarct model. The mortality in these experiments was high because of engorgement of the myocardium over time, so when Beck and Mako 9a repeated these experiments in 1941 they used a partial occlusion rather than complete occlusion.…”

mentioning

confidence: 99%

Coronary Venous Interventions

Faxon

2015

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

C oronary revascularization can salvage ischemic myocardium, relieve symptoms, and prolong life in patients with high-risk acute coronary syndrome and in patients with severe coronary artery disease. It is no wonder that coronary artery bypass surgery and percutaneous coronary interventions (PCI) were preformed on nearly 900 000 patients in the United States in 2010.1 Despite the advances with both revascularization techniques, there are many situations where improvement is still needed. For instance, myocardial salvage in ST-segmentelevation myocardial infarction with primary PCI averages only 40% to 50% of the area at risk despite timely reperfusion and many patients with multivessel disease continue to have severe angina and ischemia because of anatomy that is not amenable to revascularization. As many as 7% or 1.8 million individuals are estimated to be unrevascularizable and the treatment options for these patients are limited and often unsuccessful.2,3 Recently, several articles have been published suggesting that retrograde perfusion via the coronary sinus may have promise as a treatment option for these patients.In a study by Verheye et al, 4 104 patients with severe angina who were not candidates for revascularization were randomized to partial coronary venous occlusion accomplished by placement of an hourglass stent in the coronary sinus or to a sham operation. The stent partially obstructs the coronary sinus leading to increased retrograde flow into the ischemic territory. At 6 months, angina and quality-of-life measures were significantly improved during exercise time and wall motion index during dobutamine stress imaging were not. The study demonstrated feasibility and safety accompanied by symptomatic improvement but it failed to show improvement on functional testing. Given the small size of the study, major adverse clinical outcomes were infrequent.In a small pilot study, van de Hoef et al 5 showed that in 15 patients with stable angina undergoing PCI of the left anterior descending artery (LAD), intermittent occlusion of the coronary sinus with a balloon catheter (pressure-controlled intermittent coronary sinus occlusion [PICSO]) was safe. The goal of this technique is to increase coronary sinus pressure to its maximum with balloon occlusion and then to allow complete washout after deflation. During PCI, PICSO increased distal LAD coronary wedge pressure and reduced ST segment changes consistent with reduction in acute ischemia. In an initial feasibility study by the same authors, 30 patients with anterior ST-segment-elevation myocardial infarction undergoing primary PCI were studied with PICSO. 6 Only 19 had successful PICSO for 90 minutes and 1 patient developed tamponade. When compared with historical patients, magnetic resonance imaging infarct size was not significantly different between PICSO and controls but in those with high quality PICSO, late improvement in infarct size was seen. Further studies are planned to validate these preliminary findings.The rationale for considering coronary ...

show abstract

Experimental Attempts to Increase the Blood Supply to the Dog's Heart by Means of Coronary Sinus Occlusion

Cited by 86 publications

References 5 publications

A novel strategy for increasing wall thickness of coronary venules prior to retroperfusion

A novel strategy for increasing wall thickness of coronary venules prior to retroperfusion

The Puzzle of Positive Results — Myocardial Revascularization

Coronary Venous Interventions

Contact Info

Product

Resources

About