Hypothermic coronary venous phased retroperfusion: a closed-chest treatment of acute regional myocardial ischemia.

Abstract

SUMMARY Hypothermic synchronized retroperfusion (HSRP) was applied in closed-chest dogs after acute coronary occlusion to determine whether this intervention can significantly retard the otherwise rapidly developing irreversible ischemic injury. The left anterior descending coronary artery (LAD) was occluded for 3 hours in 22 dogs and for 6 hours in 16 dogs. Starting 30 minutes after occlusion, HSRP was applied during maintained coronary occlusion in 21 dogs. The remaining dogs served as untreated controls. Arterial blood was cooled to 20°C and retroperfused in diastole into the regional coronary veins. Hemodynamics, contrast cineangiography and two-dimensional echocardiography were measured sequentially. Glycogen-depleted ischemic areas and necrotic zones were delineated in transverse slices of the left ventricle.Untreated control dogs further deteriorated; in contrast, HSRP between 30 minutes and 3-or 6-hour LAD occlusion significantly reduced the rate-pressure product (21.3 ± 4.0% or 26.8 ± 8.2%) and left ventricular end-diastolic pressure (39.5 ± 9.5% or 51.4 ± 7.7%) and increased ejection fraction (28 ± 17% and 33 ± 2.0%). HSRP caused no arrhythmias and led to much less necrosis of ischemic myocardium in the treated 3-or 6-hour occlusion series (7.4 ± 2.7% or 28.9 ± 12.6%) than in respective untreated controls (47.1 ± 8.9% and 72.3 ± 5.9%).Moderately hypothermic closed-chest phased retroperfusion appears to protect reversibly injured ischemic myocardium and improve cardiac function. Such treatment may be particularly suitable in the earliest stages of evolving myocardial infarction, when maintenance of myocardial viability is essential for preservation of jeopardized myocardium while awaiting coronary bypass revascularization or nonsurgical thrombolytic reperfusion.

PICSO: from myocardial salvage to tissue regeneration

“…Further studies showed the effects of coronary sinus occlusion techniques on the behavior of the coronary microcirculation [17]. Corday and Meerbaum [18,19] developed interventional retroperfusion methods such as synchronized retroperfusion (SRP) and applied them clinically, forcing arterial blood retrograde via a catheter system during diastole into the ischemic microcirculation (see video 1) [20]. Further research was halted following a combination of ambivalent results, unstable technology and the development of alternatives.…”

Myocardial contrast echocardiography: a reproducible technique of myocardial opacification for identifying regional perfusion deficits.

“…Segmental and global contractile function were assessed from computations of percent fractional area changes (FACs), as previously reported. 18 21,22 Myocardial Opacification by Contrast Echocardiogram Two-dimensional echocardiography after intracoronary injections of a contrast material was used to define the zone of severely underperfused myocardium based on regional differences in left ventricular wall echo intensity. The contrast material was a 3:2 mixture of saline and Renografin, agitated by mixing during passage through a three-way stopcock.…”

Factors affecting penetration of retrograde coronary venous injections into normal and ischemic canine myocardium: assessment by contrast echocardiography and digital angiography

“…Numerous experimental studies investigated the coronary venous system as an alternate means for delivery of therapeutic interventions to jeopardized ischemic myocardium (8,(11)(12)(13)(14)(15)). Yet only limited information is available about the coronary venous system and, particularly, its myocardial microcirculation, clearly important anatomic determinants of both the location and degree of regional myocardial drainage.…”