Anatomic and hemodynamic considerations influencing the efficiency of retrograde cardioplegia

Ruengsakulrach, Permyos; Buxton, Brian F.

doi:10.1016/s0003-4975(00)01991-3

Cited by 44 publications

(29 citation statements)

References 47 publications

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“…15 Higher infusion pressure, longer incubation time, or use of drugs to increase vascular permeability may be useful in achieving higher efficiency of cell delivery into the myocardial interstitium via the retrograde intracoronary route. [11][12][13] Changes in the number of surviving MPCs in MI hearts between 10 minutes and day 3 after retrograde intracoronary infusion were distinct from one in intact hearts. The number decreased from 29.8% to 23.7% in MI hearts, whereas it increased from 31.4% to 33.0% in intact hearts during this period.…”

Section: Discussionmentioning

confidence: 91%

“…8 -10 Retrograde intracoronary delivery has been reported to be useful in administrating cardioplegic solution, peptide, and vectors for gene therapy into the myocardium using large animal models. [11][12][13][14] Emigration of inflammatory cells into the myocardial interstitium is known to take place at postcapillary venules rather than at arterioles or capillaries. 15 One could therefore hypothesize that retrograde intracoronary infusion might offer a safer and more efficient cell dissemination within the myocardium even in ischemic or infarcted areas where antegrade arterial delivery may have limited efficacy.…”

mentioning

confidence: 99%

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Targeted Cell Delivery Into Infarcted Rat Hearts by Retrograde Intracoronary Infusion: Distribution, Dynamics, and Influence on Cardiac Function

et al. 2004

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Background-Intracoronary infusion for cell transplantation has potential advantages in disseminating cells globally into the myocardium with less injury over direct intramuscular injection. Arterial route, however, has a risk of coronary embolism and a limitation in cell delivery into ischemic or infarcted areas. We assessed the efficiency of retrograde intracoronary cell implantation into infarcted hearts using a novel rat model. Methods and Results-After left coronary artery ligation in rat, a catheter was inserted into the left cardiac vein, which drains the left ventricular free wall. Through this, 1ϫ10 6 skeletal muscle precursor cells expressing nuclear ␤-galactosidase were infused retrogradely into the vein. In situ staining demonstrated that ␤-galactosidase-expressing donor cells had disseminated throughout the left ventricular free wall, including both infarcted and surrounding border areas, at 10 minutes after infusion. At 28 days, in contrast, positively stained multinuclear myotubes were found in border zones, whereas no positive cells were seen in infarcted areas. Measurement of ␤-galactosidase enzyme activity estimated that 29.8Ϯ6.9% of total infused cells were retained within the myocardium at 10 minutes and that this number decreased to 23.7Ϯ8.1% at 3 days but rapidly increased thereafter, reaching a plateau at 90.2Ϯ17.1% by 14 days. Echocardiography and Langendorff perfusion demonstrated that cell implantation improved cardiac function and dimensions by 28 days, compared with both sham-treated and phosphate-buffered saline-infused infarcted hearts, and this was associated with decreased collagen deposition. Conclusion-Retrograde intracoronary cell transplantation could provide an effective cell delivery into infarcted hearts and could be a useful strategy for treating myocardial infarction.

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Section: Discussionmentioning

confidence: 91%

mentioning

confidence: 99%

Targeted Cell Delivery Into Infarcted Rat Hearts by Retrograde Intracoronary Infusion: Distribution, Dynamics, and Influence on Cardiac Function

et al. 2004

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“…2 Moreover, anatomic variations are common in the coronary sinus and cardiac veins. 7 Veno-venous anastomoses through which the cardioplegic solution is shunted may also adversely affect the cardioplegic distribution and nutritive flow of the myocardial capillary beds. When the retroperfusion catheter is placed too deeply by the conventional transatrial technique, the cardioplegic solution may regurgitate into the right atrium if there are several veno-venous anastomoses (Fig.…”

Section: Discussionmentioning

confidence: 99%

Occluding the Junction of the Middle Cardiac Vein in Retrograde Cardioplegia: A New Retrograde Cannula for Optimizing Retrograde Cardioplegic Delivery

Matsui

Shimura²,

Sasaki

2006

Surg Today

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Retrograde cardioplegia often fails to provide adequate perfusion of the right ventricle and the posterior wall of the left ventricle because of the shunt through the thebesian vein. However, much of the retrograde cardioplegic solution may leak into the right atrium after veno-venous anastomoses at the apex of the heart, especially when a retrograde balloon cannula is inserted too deeply in the great cardiac vein, although this is not widely recognized. We designed a new retrograde cardioplegic cannula with three self-inflating balloons, which reduced the shunt flow by occluding the junction of the middle cardiac vein and improving in cardioplegic delivery. We describe the myocardial dye distribution achieved by using this new cannula in pig hearts and report the results of its clinical application.

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“…These anomalies are variable. 6 They range from absence of the coronary sinus, associated with a persistent left superior vena cava, to anomalies that entail venous connections with the left atrium, hepatic vein, or anomalous pulmonary veins. Even arteriovenous fistulous connections between the coronary sinus and coronary arteries have been described.…”

Section: Myocardial Protectionmentioning

confidence: 99%

Cardiopulmonary bypass for adults with congenital heart disease: pitfalls for perfusionists

et al. 2006

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The fixed incidence of congenital heart defects and improved survival have resulted in increasing numbers of adults with congenital heart disease (CHD) who have undergone complex repairs and/or palliations. Eventually, there will be more adults with CHD than children. They will require cardiac surgical interventions associated with progression of their CHD or for age-related disease, such as coronary revascularization. During bypass, anatomical shunts may exist within or without the heart. Left-to-right shunts can result in dramatically lower systemic blood flow than pump flow due to 'steal', while pulmonary edema ensues due to excessive pulmonary flow. Right-to-left shunts carry risks of massive air embolism and double or triple venous cannulation may be necessary. Cannulation of composite reconstructed aortas may be difficult, risking dissection or aortic obstruction, and double arterial cannulation may be indicated. Aberrant coronary arterial and venous anatomy may .preclude adequate myocardial preservation with common techniques and can be complicated by aortic insufficiency. Valves and conduits may exhibit failure. Conventional monitoring, such as central venous oximetry, may be misleading. Monitoring, such as serial lactate measurement, near-infrared spectroscopy and transcranial Doppler blood velocity, offer advantages for such patients. The perfusionist needs to be aware of such conditions as much congenital aberrancy may present unexpectedly during cardiac surgery.

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Anatomic and hemodynamic considerations influencing the efficiency of retrograde cardioplegia

Cited by 44 publications

References 47 publications

Targeted Cell Delivery Into Infarcted Rat Hearts by Retrograde Intracoronary Infusion: Distribution, Dynamics, and Influence on Cardiac Function

Targeted Cell Delivery Into Infarcted Rat Hearts by Retrograde Intracoronary Infusion: Distribution, Dynamics, and Influence on Cardiac Function

Occluding the Junction of the Middle Cardiac Vein in Retrograde Cardioplegia: A New Retrograde Cannula for Optimizing Retrograde Cardioplegic Delivery

Cardiopulmonary bypass for adults with congenital heart disease: pitfalls for perfusionists

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