Myocardial blood supply through a direct left ventricle–coronary artery shunt is not aided by augmented coronary capacitance

Zeeuw, Sandra de; Borst, Cornelius; Gründeman, Paul F.

doi:10.1016/j.jtcvs.2003.09.039

Cited by 4 publications

(1 citation statement)

References 12 publications

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“…Recently, de Zeeuw et al investigated whether augmentation of the coronary compliance during LV-CA shunting would improve net forward flow by enhancing forward flow in early diastole without reducing forward flow in systole [16]. Increased compliance was obtained by connecting a blind stump of the right internal thoracic artery (15 cm) to the distal LAD.…”

Section: Direct Revascularizationmentioning

confidence: 99%

Myocardial blood supply by left ventricle-to-coronary artery channel: An old idea revisited

Engbers

Zeeuw

Visser

et al. 2006

International Journal of Cardiology

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Coronary artery disease is one of the most important causes of death in Western society. Attempts to revascularize the coronary artery by myocardial retroperfusion, direct revascularization from the left ventricle, and bypass surgery have finally led to percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) as standard treatment for coronary artery disease.Direct revascularization from the left ventricle has already been studied in the late 1960s, but the idea was rejected because of a decrease in flow in combination with a failure of myocardial function. Recently, a left ventricle-to-coronary artery (LV-CA) stent has renewed interest as an alternative procedure when PTCA and CABG are no option. Animal studies showed a change in flow pattern from diastolic coronary inflow at baseline to systolic coronary inflow followed by diastolic regurgitive flow during direct ventricular sourcing, resulting in a coronary flow of 50-75% of baseline flow. Global myocardial function decreased in the same extent as the coronary flow suggesting perfusioncontraction matching. In a recent pilot study in the anaesthetized pig, direct revascularization after acute proximal coronary ligation resulted in sufficient blood supply to the outer layers of the myocardium, however, in the inner layers a metabolic disbalance occurred.Incorporation of a valve-like mechanism to minimize the diastolic regurgitive flow may be necessary to improve the performance of the LV-CA stent. In addition, further research should be done in chronic ischemic animal models in which the effect of the collateral circulation on myocardial perfusion and performance is an important issue. D 2005 Elsevier Ireland Ltd. All rights reserved.Keywords: Coronary artery disease; Myocardial metabolism; Cardiac function; Coronary revascularization Myocardial revascularization: a short historical viewNowadays, coronary artery disease accounts for nearly half of the deaths in the developed world and 25% in the developing world [1,2]. Percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) are currently the standard methods for revascularization [3].In the late nineteenth century, the necessity for coronary artery surgical procedures became evident by the observation of extensive minute vascular communications between normal coronary circulation and vascular supply of surrounding extracardiac structures, such as the pericardium [4]. Procedures like reversion of coronary sinus blood by arterializing the coronary sinus, whereby coronary venous pressure was increased and reversing thebesian blood flows from the chambers back into the myocardium, and sympathectomy, which relieved the sensation of angina and produced a state of coronary vasodilation, were explored and became standard procedures for several years. Moreover, Beck suggested arterializing the coronary sinus thereby attempting to create retroperfusion of the myocardium [4].

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Section: Direct Revascularizationmentioning

confidence: 99%

Myocardial blood supply by left ventricle-to-coronary artery channel: An old idea revisited

Engbers

Zeeuw

Visser

et al. 2006

International Journal of Cardiology

Self Cite

View full text Add to dashboard Cite

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Computational study on the hemodynamics of the bypass shunt directly connecting the left ventricle to a coronary artery

Shim

Lee

2005

J Mech Sci Technol

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Transmural Differences in Myocardial Function and Metabolism During Direct Left Ventricular to Coronary Artery Sourcing

Zeeuw

Borst

Verlaan

et al. 2005

The Annals of Thoracic Surgery

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Myocardial blood supply through a direct left ventricle–coronary artery shunt is not aided by augmented coronary capacitance

Abstract: In healthy pigs a left ventricle-coronary artery shunt decreased net forward coronary flow to 53% +/- 18% of native flow. Augmentation of coronary artery compliance did not improve shunt performance.

Cited by 4 publications

References 12 publications

Myocardial blood supply by left ventricle-to-coronary artery channel: An old idea revisited

Myocardial blood supply by left ventricle-to-coronary artery channel: An old idea revisited

Computational study on the hemodynamics of the bypass shunt directly connecting the left ventricle to a coronary artery

Transmural Differences in Myocardial Function and Metabolism During Direct Left Ventricular to Coronary Artery Sourcing

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