The heart constitutively expresses heme oxygenase (HO)-2, which catabolizes heme-containing proteins to produce biliverdin and carbon monoxide (CO). The heart also contains many possible substrates for HO-2 such as heme groups of myoglobin and cytochrome P-450s, which potentially could be metabolized into CO. As a result of observations that CO activates guanylyl cyclase and induces vascular relaxation and that HO appears to confer protection from ischemic injury, we hypothesized that the HO-CO pathway is involved in ischemic vasodilation in the coronary microcirculation. Responses of epicardial coronary arterioles to ischemia (perfusion pressure ϳ40 mmHg; flow velocity decreased by ϳ50%; dL/dt reduced by ϳ60%) were measured using stroboscopic fluorescence microangiography in 34 openchest anesthetized dogs. Ischemia caused vasodilation of coronary arterioles by 36, indomethacin (10 mg/kg iv), and K ϩ (60 mM, epicardial suffusion) to prevent the actions of nitric oxide, prostaglandins, and hyperpolarizing factors, respectively, partially inhibited dilation during ischemia (36 Ϯ 6 vs. 15 Ϯ 4%; P Ͻ 0.05). The residual vasodilation during ischemia after antagonist administration was inhibited by tin mesoporphyrin IX (SnMP, 10 mg/kg iv), which is an inhibitor of HO (15 Ϯ 4 vs. 7 Ϯ 2%; P Ͻ 0.05 vs. before SnMP). The guanylyl cyclase inhibitor 1H-[1,2,4]oxadiazole[4,3-a]quinoxalin-1-one (10 Ϫ5 M, epicardial suffusion) also inhibited vasodilation during ischemia in the presence of L-NMMA with indomethacin and KCl. Moreover, administration of heme-L-arginate, which is a substrate for HO, produced dilation after ischemia but not after control conditions. We conclude that during myocardial ischemia, HO-2 activation can produce cGMP-mediated vasodilation presumably via the production of CO. This vasodilatory pathway appears to play a backup role and is activated only when other mechanisms of vasodilation during ischemia are exhausted. microcirculation; carbon monoxide; hypoperfusion; ischemia THE HEART REQUIRES CONTINUOUS oxygen delivery and blood flow to support the high levels of aerobic metabolism of working cardiac muscle. Interruption in coronary blood flow causes an imbalance between oxygen delivery and consumption. This imbalance results in the release of vasodilators that increase perfusion (15, 32) but to date, the identity of these vasodilators remains unclear.Carbon monoxide (CO) is an endogenously generated gas that is produced from catabolism of heme by heme oxygenase (HO). CO stimulates soluble guanylyl cyclase (GC), increases cGMP in vascular tissue, and elicits vasodilation (9, 13). HO enzyme activity has been described in numerous tissues including heart (1, 33) and vascular endothelium (35, 36). Moreover, a growing consensus is that HO activity may be cardioprotective (10, 17). Recent studies suggest that CO participates in vascular regulation during normal (23, 49) and abnormal physiological conditions including endotoxin shock (48), chronic hypoxia (6), portal hypertension (16), and subarachnoid hemorrha...