Coronary venous retroperfusion of arterial blood for the treatment of acute myocardial ischemia

Jc, Barnett; Rj, Freedman; Rc, Touchon; Mr, Mesner

doi:10.1002/ccd.1810280303

Cited by 9 publications

(2 citation statements)

References 10 publications

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“…Both techniques have been widely tested in animal models and SRP has also been evaluated in humans. 34,35 In one study, SRP was associated with a reduction in the number and severity of angina episodes and the use of nitroglycerine in patients with unstable angina. 34 SRP has also been reported to improve ventricular contractility, prevent the onset of cardiogenic shock, and reduce ST segment changes in humans with severe ischemia.…”

Section: Treatment Of Myocardial Ischemiamentioning

confidence: 99%

“…34 SRP has also been reported to improve ventricular contractility, prevent the onset of cardiogenic shock, and reduce ST segment changes in humans with severe ischemia. 33,35,36 Finally, SRP has been found to preserve myocardial viability and limit experimentally induced infarct size. 32,37,38 In the past, SRP was used as myocardial support during difficult angioplasty or as a bridge to coronary artery bypass graft after abrupt closure of an artery.…”

Section: Treatment Of Myocardial Ischemiamentioning

confidence: 99%

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Trans-Coronary-Venous Interventions

Siminiak¹,

Lipiecki²

2008

Circ: Cardiovascular Interventions

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Abstract-The coronary venous system is routinely targeted during electrophysiological measurements or cardiac resynchronization therapy. However, several novel interventional techniques require coronary venous catheterization and visualization as well as transvenous delivery of devices and/or therapeutic agents. Recent reports suggest the possibility of a transvenous approach for the interventional treatment of refractory angina and mitral valve regurgitation. In addition, the coronary venous system has been used as a route for the delivery of stem cells in patients with left ventricular dysfunction due to ischemic heart disease. We review the potential value of using a coronary venous approach in association with recent therapeutic developments in the interventional treatment of structural and ischemic heart disease. We will also discuss techniques related to coronary venous catheterization. (Circ Cardiovasc Intervent. 2008;1:134-142.)Key Words: catheterization Ⅲ catheters Ⅲ valves Ⅲ valvuloplasty Ⅲ veins M ore than a century ago, Pratt 1 first described the use of coronary veins to deliver arterial blood to ischemic myocardium. His experiments showed that the coronary veins could be used as conduits for oxygenated blood and could preserve myocardial viability in the absence of normal arterial perfusion. Early in the 20th century, Beck described a procedure to treat patients with severe angina. Coronary venous pressures were elevated by surgically narrowing the coronary sinus (CS) in association with a partial pericardectomy. [2][3][4] This procedure known as the Beck I procedure was later modified to include a vein graft from the descending aorta to the great cardiac vein and partial ligation of the CS. Thus, in the Beck II procedure, the coronary venous system was partially arterialized. Several patients reported relief from anginal symptoms. These elegant operations were performed many years before the first coronary artery bypass graft surgeries and without the aid of cardiopulmonary bypass equipment. However, with the introduction of coronary artery bypass surgery and because of the long-term complications resulting from permanent obstruction of venous drainage including CS thrombosis, late myocardial hemorrhage, venous engorgement, edema, and subsequent fibrosis, these techniques were abandoned in the mid-1970s.Because of the enormous progress in the treatment of ischemic heart disease in the second half of the 20th century, there is a growing population of patients with chronic heart disease, severely altered contractile function, refractory ischemia, and/or functional mitral regurgitation (MR) who are not good candidates for surgery.Recently, several techniques using coronary venous access have been developed for targeted delivery of pharmacological agents, mechanical devices, or stem cells.In this study, we review the anatomy of the coronary venous system and focus on its potential value for new therapeutic approaches in invasive cardiology. The use of the coronary venous system for routine electrophys...

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Section: Treatment Of Myocardial Ischemiamentioning

confidence: 99%

Section: Treatment Of Myocardial Ischemiamentioning

confidence: 99%

Trans-Coronary-Venous Interventions

Siminiak¹,

Lipiecki²

2008

Circ: Cardiovascular Interventions

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Combined intraaortic balloon counterpulsation with synchronized coronary venous retroperfusion: The united states experience

Freedman

Lasorda

O’Neill

1994

Cathet. Cardiovasc. Diagn.

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Prompted by severe cardiogenic shock, impending or manifest, three cases from the United States Retroperfusion Clinical Trials utilized intraaortic balloon counterpulsation combined with retroperfusion. Temporary stabilization and improvement was noted in all three cases and long-term survival was seen in two of the cases. The clinical and physiologic bases for combined use of these modalities is discussed.

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Intraaortic balloon counterpulsation with synchronized coronary venous retroperfusion: The united states experience

Smalling

1994

Cathet. Cardiovasc. Diagn.

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Several groups have demonstrated the utility of coronary sinus retroperfusion in unstable angina [ 1,2] as well as in the setting of PTCA [3]. We attempted to determine whether coronary sinus retroperfusion could in fact support the circulation or at least partially support regional function during a failed PTCA in an animal model. We found that with adequate coronary sinus retroperfusion, the dyskinesis occurring with left anterior descending occlusions could be improved to akinesis; however, the myocardium still failed to contract during profound ischemia [4]. Unfortunately, during circumflex ischemia in the same animal model, coronary sinus retroperfusion appeared to do little to support mechanical function [4].Verdouw and colleagues [5] suggested that for regional function to be maintained in the pig model with retroperfusion, very high coronary sinus pressures were necessary. These pressures did support reasonable function for a brief period of time; however, subsequently edema in the myocardium developed with further compromise in regional function [ 5 ] . The novel modification described in this report is that of combined intraaortic balloon counterpulsation with coronary sinus retroperfusion. This certainly represents a technical tour-de-force and seemed to achieve an improved physiologic outcome in several patients. The modest decompression of the left ventricle that occurs with intraaortic balloon counterpulsation certainly could improve the collateral pressure gradient induced by coronary sinus retroperfusion.One must ask the question, however: Is this approach practical? The CPS investigators have shown us that it is extremely difficult to predict those patients who will suffer hemodynamic compromise during coronary angioplasty, excluding patients with PTCA of the last remaining vessel. Hence, if failed angioplasty unexpectedly produces hemodynamic compromise that is not readily reversible by intraaortic balloon counterpulsation, one is faced with the prospect of doing an internal jugular or subclavian puncture in heparinized patients. Clearly, such an intervention would be risky, and placement of the coronary sinus catheter via the femoral vein is difficult at best. Coronary sinus catheterization is difficult even in the most experienced of hands, and I think it would be unlikely for routine operators to be able to do this quickly in the setting of patients undergoing CPR or other heroic means to maintain some semblance of circulatory stability. Although the coronary sinus support catheter can be put in through the venous route, arterial blood is necessary for delivery to the distal coronary venous circulation, and hence it is usually necessary to place an arterial supply catheter in addition to the coronary sinus catheter for successful retroperfusion. It might be feasible to use an oversized sheath in the artery that is used for the coronary artery intervention for the source of arterial blood, but clearly, if one has an intraaortic balloon pump in one groin and angioplasty guide catheter in the o...

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Coronary venous retroperfusion of arterial blood for the treatment of acute myocardial ischemia

Cited by 9 publications

References 10 publications

Trans-Coronary-Venous Interventions

Trans-Coronary-Venous Interventions

Combined intraaortic balloon counterpulsation with synchronized coronary venous retroperfusion: The united states experience

Intraaortic balloon counterpulsation with synchronized coronary venous retroperfusion: The united states experience

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