| Myocardial blood supply by left ventricle-to-coronary artery channel: an old idea revisited. | |
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MedLine Citation:
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PMID: 16321684 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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 perfusion-contraction 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. |
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Authors:
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Hannelie M Engbers; Sandra de Zeeuw; Tjaakje Visser; Maarten-Jan M Cramer; Paul F Gründeman |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Review |
Journal Detail:
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Title: International journal of cardiology Volume: 106 ISSN: 0167-5273 ISO Abbreviation: Int. J. Cardiol. Publication Date: 2006 Jan |
Date Detail:
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Created Date: 2005-12-02 Completed Date: 2006-03-16 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8200291 Medline TA: Int J Cardiol Country: Ireland |
Other Details:
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Languages: eng Pagination: 145-51 Citation Subset: IM |
Affiliation:
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Heart Lung Center Utrecht, Experimental Cardiology Laboratory, University Medical Center Utrecht, The Netherlands. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Blood Flow Velocity
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physiology Coronary Circulation / physiology* Coronary Disease / surgery* Coronary Vessels / surgery* Heart Ventricles / surgery* Humans Microdialysis Myocardial Revascularization / methods* Myocardium / metabolism* Stents* |
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