Myocardial function and transmural blood flow during coronary venous retroperfusion in pigs.

Oh, BH; Volpini, M; Kambayashi, Masashi; Murata, Kazuya; Rockman, H. A.; Kassab, Ghassan S.; Ross, John

doi:10.1161/01.cir.86.4.1265

Cited by 36 publications

(15 citation statements)

References 45 publications

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“…The left ventricular myocardium demonstrates transmural heterogeneity of strain distribution. It has been reported that, under normal circumstances, the subendocardial myocardium receives more blood flow and consumes more oxygen than the subepicardial one (20,28,35). Moreover, there is a transmural gradient of contractile function in the left ventricular wall, with greatest amount of thickening occurring in the subendocardial myocardium (6,25).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of transmural distribution of viable muscle by myocardial strain profile and dobutamine stress echocardiography

Maruo

Nakatani²,

Jin³

et al. 2007

American Journal of Physiology-Heart and Circulatory Physiology

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bution of viable myocardium in the ischemic myocardium has not been quantified and fully elucidated. To address this issue, we evaluated transmural myocardial strain profile (TMSP) in dogs with myocardial infarction using a newly developed tissue strain imaging. TMSP was obtained from the posterior wall at the epicardial left ventricular short-axis view in 13 anesthetized open-chest dogs. After control measurements, the left circumflex coronary artery was occluded for 90 min to induce subendocardial infarction (SMI). Subsequently, latex microbeads (90 m) were injected in the same artery to create transmural infarction (TMI). In each stage, measurements were done before and after dobutamine challenge (10 g ⅐ kg Ϫ1 ⅐ min Ϫ1 for 10 min) to estimate transmural myocardial viability. Strain in the subendocardium in the control stage increased by dobutamine (from 53.6 Ϯ 17.1 to 73.3 Ϯ 21.8%, P Ͻ 0.001), whereas that in SMI and TMI stages was almost zero at baseline and did not increase significantly by dobutamine [from 0.8 Ϯ 8.8 to 1.3 Ϯ 7.0%, P ϭ not significant (NS) for SMI, from Ϫ3.9 Ϯ 5.6 to Ϫ1.9 Ϯ 6.0%, P ϭ NS for TMI]. Strain in the subepicardium increased by dobutamine in the control stage (from 23.9 Ϯ 6.1 to 26.3 Ϯ 6.4%, P Ͻ 0.05) and in the SMI stage (from 12.4 Ϯ 7.3 to 27.1 Ϯ 8.8%, P Ͻ 0.005), whereas that in the TMI stage did not change (from Ϫ1.0 Ϯ 7.8 to Ϫ0.7 Ϯ 8.3%, P ϭ NS). In SMI, the subendocardial contraction was lost, but the subepicardium showed a significant increase in contraction with dobutamine. However, in TMI, even the subepicardial increase was not seen. Assessment of transmural strain profile using tissue strain imaging was a new and useful method to estimate transmural distribution of the viable myocardium in myocardial infarction. myocardial infarction; strain; viability; echocardiography IT IS WELL KNOWN that myocardial contraction has transmural heterogeneity. Several experimental studies confirmed that the subendocardium contributes greater to overall myocardial thickening than the subepicardium (6, 25). On the other hand, when a reduction of coronary blood flow occurs, a severe reduction of perfusion and kinesis occurs in the subendocardium, but only a trivial reduction can be detected in the subepicardium (5, 31). After a long period of ischemia, myocardial necrosis progresses from the endocardium to the epicardium (8, 13).Myocardial strain reflects regional myocardial function. With the recent advancement of tissue Doppler echocardiography, myocardial strain can be obtained noninvasively (3, 33) and has been reported to be useful to quantify regional myocardial systolic function in ischemic heart disease (9, 11, 24, 29, 36). The recently developed myocardial strain imaging system provides us myocardial strain in each wall layer and shows its distribution in a form of transmural myocardial strain profile (TMSP; see Ref. 1). Thus combination of TMSP and dobutamine stress echocardiography (DSE), which has been used for the assessment of myocardial viability (18), is expected to demonstr...

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Section: Discussionmentioning

confidence: 99%

Evaluation of transmural distribution of viable muscle by myocardial strain profile and dobutamine stress echocardiography

Maruo

Nakatani²,

Jin³

et al. 2007

American Journal of Physiology-Heart and Circulatory Physiology

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“…It is likely that blood entering the myocardium by patent channels is drained by the sinusoidal channel system [14, 15]. There is evidence that perfusion of the sinusoidal system can take over nutritive function [16, 17]and reestablish a sufficient myocardial blood supply. Transmyocardial channels created by laser remained longer patent than those produced by needle acupuncture [18]; however, in investigations with serial follow-up, it was documented that most of the transmyocardial laser channels occlude within weeks after their generation and that they are replaced by fibrous tissue [19, 20, 21].…”

Section: Discussionmentioning

confidence: 99%

Myocardial Angiogenesis Resulting in Functional Communications with the Left Cavity Induced by Intramyocardial High-Frequency Ablation: Histomorphology of Immediate and Long-Term Effects in Pigs

Dietz

Horstick²,

Manke³

et al. 2003

Cardiology

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A previous study in rabbit hearts demonstrated the feasibility of creating transmyocardial channels by application of temperature-regulated high-frequency (HF) energy. Feasibility of creating non-transmural channels using a transvascular approach was tested in 14 pigs which were followed for 1 h, and 3 and 9 weeks (group A, B and C). Myocardial channels were found to be highly reproducible and patent in more than two thirds in group A. Channels were replaced by connective tissue during follow-up which contained newly formed small vessels. A functional communication between the left ventricular cavum and newly formed vessels of the channel remnants could be demonstrated in one heart of group C. Thus, intramyocardial HF ablation can be performed with high reproducibility to induce local angiogenesis.

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“…In 1948, Beck and colleagues (5) performed the coronary retroperfusion procedure in humans. The method was abandoned, however, because of the high mortality rate from the edema and hemorrhage in the postcapillary venules that resulted from the elevated pressure (6,8,12,26). To remedy these difficulties, we propose to avoid raising the pressure in the left anterior descending (LAD) vein from venous (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) to arterial values (100 -120 mmHg) in a single step.…”

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confidence: 99%

A novel strategy for increasing wall thickness of coronary venules prior to retroperfusion

Choy

Kassab²

2006

American Journal of Physiology-Heart and Circulatory Physiology

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Choy, Jenny Susana, and Ghassan S. Kassab. A novel strategy for increasing wall thickness of coronary venules prior to retroperfusion. Am J Physiol Heart Circ Physiol 291: H972-H978, 2006. First published April 7, 2006 doi:10.1152/ajpheart.00235.2006.-The sudden exposure of veins to arterial pressures during coronary venous retroperfusion may cause rupture of small venules. Our rationale is to first occlude the coronary vein, which will cause an increase in pressure intermediate to arterial and venous values, and hence lead to remodeling and increased wall thickness of the veins prior to retroperfusion. To accomplish this objective, five pigs were subjected to left anterior descending (LAD) vein ligation while six pigs served as sham. Myocardial tissue samples were obtained from the area adjacent to the LAD vein at four transmural locations of the left ventricular free wall: epicardial surface, subepicardium, midmyocardium, and endocardium. Arterioles and venules from the experimental and sham control groups were photographed, and the following measurements were made: inner and outer circumferences, inner and outer areas, major and minor diameters, and intima-media thickness. Each vessel was categorized in four different orders according to lumen diameter. Our results show that intima-media thickness was larger in the experimental group in all four regions of the heart and in all four orders of the vessels, although venules from the epicardial region showed the largest increase in thickness. The intima-media thicknessto-radius ratio was also larger in the experimental group and decreased from epicardial to endocardial region of the heart and from order 1 to order 4 of the vessels. The present study provides a rationale for the development of coronary retroperfusion strategy that avoids vessel rupture and hemorrhage in the postcapillary venules. pressure overload; arterialization; rupture stress; remodeling; ligation BECAUSE THE CORONARY VEINS rarely develop arteriosclerosis (8,23,24), it is desirable to use these vessels as conduits for revascularization. The possibility of coronary retroperfusion was first suggested by Pratt (27) in 1898, when he was able to sustain the mechanical function of a cat's heart by delivering oxygenated blood through the coronary sinus. Almost 50 years after this seminal study, the first attempts at arterialization of the coronary sinus were made by Roberts et al. (30) and Beck et al. (5), independently. In 1943, Roberts et al. (30) suggested the use of coronary veins as conduits to deliver oxygenated blood in a retrograde manner in animal studies. In 1948, Beck and colleagues (5) performed the coronary retroperfusion procedure in humans. The method was abandoned, however, because of the high mortality rate from the edema and hemorrhage in the postcapillary venules that resulted from the elevated pressure (6,8,12,26). To remedy these difficulties, we propose to avoid raising the pressure in the left anterior descending (LAD) vein from venous (10 -20 mmHg) to arterial values (100 ...

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Myocardial function and transmural blood flow during coronary venous retroperfusion in pigs.

Cited by 36 publications

References 45 publications

Evaluation of transmural distribution of viable muscle by myocardial strain profile and dobutamine stress echocardiography

Evaluation of transmural distribution of viable muscle by myocardial strain profile and dobutamine stress echocardiography

Myocardial Angiogenesis Resulting in Functional Communications with the Left Cavity Induced by Intramyocardial High-Frequency Ablation: Histomorphology of Immediate and Long-Term Effects in Pigs

A novel strategy for increasing wall thickness of coronary venules prior to retroperfusion

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