Intercoronary Anastomoses in Congenital Heart Disease

Bloor, Colin M.; Keefe, John F.; Browne, Marie J.

doi:10.1161/01.cir.33.2.227

Cited by 13 publications

(5 citation statements)

References 12 publications

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“…It was unexpected that fetal human hearts contained more native collaterals than the injured neonate and adult mouse as well as diseased adult human hearts, although it is difficult to make comparisons between whole-organ α-SMA staining and angiograms. This finding corresponds with data that suggests collaterals tend to decrease during adolescent years because more were found in the fetal stages compared to neonate humans 57,58 .…”

Section: Discussion__________________________________________________supporting

confidence: 91%

“…Using post-mortem perfusions, studies from the 1960s reported the presence of coronary collateral arteries in infants and children 57,58 , but no one has reported whether collaterals develop during embryogenesis. Furthermore, using smooth muscle coverage to identify collateral connections in humans has not been done.…”

Section: Human Fetal and Adult Coronary Collateral Arteriesmentioning

confidence: 99%

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Blood flow modeling reveals improved collateral artery performance during the regenerative period in mammalian hearts

et al. 2022

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Collateral arteries are a vessel subtype that bridges two artery branches, forming a natural bypass that can deliver blood flow downstream of an occlusion. These bridges in the human heart are associated with better outcomes during coronary artery disease.We recently found that their rapid development in neonates supports heart regeneration, while the non-regenerative adult heart displays slow and minimal collateralization. Thus, inducing robust collateral artery networks could serve as viable treatment for cardiac ischemia, but reaching this goal requires more knowledge on their developmental mechanisms and functional capabilities. Here, we use whole-organ imaging and 3D computational fluid dynamics (CFD) modeling to identify the spatial architecture of and predict blood flow through collaterals in neonate and adult hearts.We found that neonate collaterals are more numerous, larger in diameter, and, even when similar in size/number, are predicted to more effectively re-perfuse an occluded coronary network when compared to adults. CFD analysis revealed that collaterals perform better in neonates because of decreased differential pressures along their coronary artery tree. Furthermore, testing of various collateral configurations indicated that larger, more proximal collaterals are more beneficial than many smaller ones, identifying a target architecture for therapeutic interventions. Morphometric analysis revealed how the coronary artery network expands during postnatal growth. Vessel diameters do not scale with cardiac muscle growth. Instead, the coronary tree expands solely by adding additional branches of a set length, a burst of which occurs during murine puberty. Finally, we compared mouse structural and functional data to human hearts. Surprisingly, fetal human hearts possessed a very large number of small, but mature, smooth muscle cell covered collaterals while angiogram data indicated adult patients with chronic coronary occlusions contained at least two. Comparing size ratios with modeled mouse data suggested low re-perfusion capabilities of the embryonic collaterals but higher functional benefits of those in diseased adults. Our unique interdisciplinary approach allowed us to quantify the functional significance of collateral arteries during heart regeneration and repair-a critical step towards realizing their therapeutic potential.

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Section: Discussion__________________________________________________supporting

confidence: 91%

Section: Human Fetal and Adult Coronary Collateral Arteriesmentioning

confidence: 99%

Blood flow modeling reveals improved collateral artery performance during the regenerative period in mammalian hearts

et al. 2022

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“…Similar correlations were not found in normals. This finding is consistent with the concept that coronary sinus oxygen content may be a determinant of coronary blood flow when myo cardial oxygenation mechanisms are altered [Berne, 1957], Enlargement of the coronary arteries has been noted as a response both to hypertrophy and chronic hypoxia in experimental animals [Kerr, 1965], and increased inter-coronary anastomoses have been found in young children with con genital heart disease [Bloor, 1966], Large coronary arteries have been occasionally described in cyanotic congenital heart disease [Bjork, 1966;P erloff, 1968] but there is no evidence that this is a general phenomenon. Changes in coronary bed such as these might make great increases in coronary blood flow possible.…”

Section: Coronary Flow and Myocardial Oxygen Delivery During Stresssupporting

confidence: 89%

Myocardial Metabolism in Cyanotic Congenital Heart Disease

Scheuer¹,

Shaver²,

Kroetz³

et al. 1970

Cardiology

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Eight normal subjects and 7 cyanotic patients, 5 with tetralogy of Fallot, and 2 with Eisenmenger’s syndrome, were studied with coronary sinus catheterization. In the resting state mean coronary flows were lower and myocardial oxygen extractions higher in cyanotic patients so that myocardial oxygen consumption was the same in the 2 groups. Coronary flows appeared to be inversely related to hematocrit in the cyanotic group. Myocardial lactate balance was similar in the 2 groups, but coronary sinus lactate/ pyruvate ratios were frequently higher than arterial ratios in the cyanotic group. The subjects were stressed with supine leg exercise or with an isoproterenol infusion. In cyanotic subjects exercise caused a fall in arterial oxygen and myocardial oxygen extraction so that oxygen delivery tended to be more dependent upon coronary flow. Myocardial oxygen delivery appeared adequate during stress in cyanotic patients and lactate and pyruvate analysis failed to show evidence of myocardial hypoxia. Between the 3rd and 8th min of exercise, cyanotic patients continued to have falling arterial oxygen values and rising arterial lactate and lactate/pyruvate ratios indicating that they had not reached steady metabolic state. Myocardial glucose and free fatty acid uptake were similar in the 2 groups. These results indicate that although the mechanisms of oxygen delivery to the myocardium may differ in normals and some patients with cyanotic congenital heart disease, left ventricular myocardial oxidative metabolism is intact even in the presence of hypoxemia.

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“…Directed by the concentration of local messenger substance, endothelial precursor cells sprout out and start forming a dense vascular network with multiple anastomoses. The density of this network is at its peak in neonates and declines subsequently by physiological regression, a process called pruning [14,15,16].…”

Section: Basic Principles Of the Human Coronary Collateral Circulamentioning

confidence: 99%

The Human Coronary Collateral Circulation, Its Extracardiac Anastomoses and Their Therapeutic Promotion

Bigler

Seiler

2019

IJMS

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Cardiovascular disease remains the leading global cause of death, and the number of patients with coronary artery disease (CAD) and exhausted therapeutic options (i.e., percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and medical treatment) is on the rise. Therefore, the evaluation of new therapeutic approaches to offer an alternative treatment strategy for these patients is necessary. A promising research field is the promotion of the coronary collateral circulation, an arterio-arterial network able to prevent or reduce myocardial ischemia in CAD. This review summarizes the basic principles of the human coronary collateral circulation, its extracardiac anastomoses as well as the different therapeutic approaches, especially that of stimulating the extracardiac collateral circulation via permanent occlusion of the internal mammary arteries.

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Intercoronary Anastomoses in Congenital Heart Disease

Cited by 13 publications

References 12 publications

Blood flow modeling reveals improved collateral artery performance during the regenerative period in mammalian hearts

Blood flow modeling reveals improved collateral artery performance during the regenerative period in mammalian hearts

Myocardial Metabolism in Cyanotic Congenital Heart Disease

The Human Coronary Collateral Circulation, Its Extracardiac Anastomoses and Their Therapeutic Promotion

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