Blood flow capacity via direct acute myocardial revascularization

Abstract

The concept of direct myocardial revascularization, achieving myocardial perfusion through means other than the normal coronary vasculature, has a long history with the most widely investigated technique being the Vineberg procedure; current interest centers around the encouraging preliminary clinical results obtained with transmyocardial laser revascularization. Despite significant previous research, the acute blood flow potential through the direct myocardial route remains unknown. Nontransmural laser channels were made in the distal LAD territory from the epicardial surface of 5 mongrel dogs to which an internal mammary artery was connected. A flow probe was placed on the distal most portion of the artery and an intercostal branch was cannulated for infusion of colored microspheres. Measurements were taken under baseline conditions and following LAD and epicardial collateral ligation. Under all conditions, blood flow pattern was of a to-and-fro nature. At baseline, there was an average 0.60 +/- 0.24 ml/min net flow into the myocardium which was all contained within 0.5 cm of the central channel with a final myocardial perfusion of 0.011 +/- 0.016 ml/min/g. Following induction of ischemia average flow increased to 1.41 +/- 0.51 ml/min which extended as far as 1 cm from the channel with a final myocardial perfusion of 0.22 +/- 0.19 ml/min/g. In conclusion, a limited amount of acute myocardial perfusion can be achieved by the present technique of direct myocardial revascularization and the amount of flow is highly dependent upon the amount of flow through the native circulation.

Clinic-Morphological Analysis of the Application of the Mononuclear Fraction of Autologous Bone Marrow Cells in Endomyocardial Implantation in a Patient With Severe Ischemic Myocardial Dysfunction of the Left Ventricle

“…с хронической сердечной недостаточностью приобретает все большее значение. Из различных ее направлений трансплантация прекультивированных мезенхимальных стволовых клеток аутологичного костного мозга является наиболее перспективной [6][7][8]. Эти клетки, будучи аутологичными для реципиента, снимают с врача этические, юридические и организационные проблемы получения донорских клеток, а также устраняют необходимость иммуносупрессивной терапии, которая обычно требуется после трансплантации эмбриональных и фетальных клеток [9].…”

Refractory heart failure

“…It may be beneficial in patients with severe ischemic heart disease not amenable to coronary artery bypass graft surgery because suitable target bypass points are absent [17][18][19][20]. This procedure employs a high-powered carbon dioxide laser beam that creates channels when fired through myocardium in regions of known ischemia.…”

Release of cardiac biochemical markers after percutaneous myocardial laser or sham procedures

“…It is not clear why laser reduces symptoms. The myocardial channels close after a short time [9][10][11][12][13], the importance of denervation is debated [14,15], placebo does not fully explain the treatment effect [16,17], stimulation of microvascular growth may not be enough to support a necessary increase in blood flow [18], and finally there has been some concern about a possible development of myocardial scarring and heart failure. Vaporization of tissue during the creation of laser channels leads to a certain loss of viable myocardium and a mandatory release of cardiac enzymes [19,20].…”