Noncoronary Collateral Myocardial Blood Flow

Brazier, John; Hottenrott, C; Buckberg, Gerald D.

doi:10.1016/s0003-4975(10)64044-1

Cited by 118 publications

(18 citation statements)

References 20 publications

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“…The influence of noncoronary collateral flow [20,21] during cardioplegic arrest on the [Cl – ] and [K + ] decrease of the coronary sinus effluent cannot be ignored because the [Cl – ] and [K + ] of circuit blood were lower than those of the BCP solution. Although noncoronary collateral flow obviously affected our results, the relative contribution of the noncoronary collateral flow to the results of the present study could not be determined because the exact volume of noncoronary collateral flow circulating in the myocardium during cardioplegic arrest during aortic cross-clamping is unknown.…”

Section: Discussionmentioning

confidence: 99%

Blood Cardioplegia Serves as a Bicarbonate Donor to the Myocardium during Ischemia: Effects of Anoxia and Hypercapnia on Acid-Base Characteristics of Blood Cardioplegic Solution

Yamamoto

Goh

Magishi³

et al. 2011

Eur Surg Res

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Objectives: We investigated the alterations of acid-base characteristics of the blood cardioplegia (BCP) solution during aortic cross-clamping in hearts arrested with BCP and during in vitro-simulated ischemia. Methods: Following aortic cross-clamping, the hearts of 40 patients undergoing cardiac surgery were intermittently infused with an 18°C BCP solution and finally with a 34°C BCP solution prior to aortic cross-clamp release. We measured the pH, partial CO₂ pressure (pCO₂), [HCO₃^–], and [Cl^–] of the coronary sinus effluent in the final BCP solution. The BCP solution was assessed under in vitro gassing at 34°C with 95% N₂ + 5% CO₂ (n = 6), 50% N₂ + 50% CO₂ (n = 3), or 100% CO₂ (n = 6). Results: The coronary sinus effluent, compared with the preinfusion BCP solution, exhibited a significantly lower pH and a greater pCO₂ with no change in the [HCO₃^–] level. In vitro, the 95% N₂ + 5% CO₂ gassing (simulated hypoxia) group exhibited a slight increase in [HCO₃^–] with no change in pCO₂ or pH whereas the 50% N₂ + 50% CO₂ gassing and the 100% CO₂ gassing (simulated hypoxia and hypercapnia) groups exhibited a significant increase in [HCO₃^–] under high pCO₂-induced acidification. Conclusions: Under anoxia and CO₂ retention during aortic cross-clamping, the BCP solution can be a bicarbonate donor to the myocardium.

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Section: Discussionmentioning

confidence: 99%

Blood Cardioplegia Serves as a Bicarbonate Donor to the Myocardium during Ischemia: Effects of Anoxia and Hypercapnia on Acid-Base Characteristics of Blood Cardioplegic Solution

Yamamoto

Goh

Magishi³

et al. 2011

Eur Surg Res

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“…The relevance of this for the noncoronary collateral circulation lies in the fact that it can supply part of the musculature and even single cells adequately with blood, while the rest of the myocardium receives marginal or insufficient blood supply. A flow of only 6 ml/min suffices to meet the metabolic demands of the arrested left ventricle at a temperature of 22 ° C [4]. However this quantity of blood is not always available.…”

Section: Discussionmentioning

confidence: 99%

“…However this quantity of blood is not always available. The flow varies greatly, depending on the variations of the systemic pressure [4,8]. The effect on the myocardium of the non-coronary collateral circulation becomes a function of the flow rate.…”

Section: Discussionmentioning

confidence: 99%

“…These non-coronary collaterals pierce the aortic and pulmonary trunks, which they serve as vasa vasorum, before they traverse the pericardial reflections at the base of the heart and anastomose with the atrial branches of the coronary arteries [2,4,6,9,10]. The presence and extent of these extracardial connections can be demonstrated by the ligation of the pulmonary artery and subsequent cardiopulmonopexy [2,10], coronary angiogram [8], or by injecting a cadmium-containing resin Biodur E 201 rot (which sets with the application of the hardener Biodur E 21) viscous enough to prevent capillary-venous passage, into the coronary main stems.…”

Section: Introductionmentioning

confidence: 99%

“…The influence of non-coronary collateral blood circulation on the electively arrested ischemic myocardium "protected" with a chemical cardioplegic solution has been a subject of much controversy [4,5,8]. The principal argument against it is its warming-up effect onthe myocardium.…”

Section: Introductionmentioning

confidence: 99%

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The influence of non-coronary collateral blood supply on the electively arrested heart during ischemia and reperfusion

et al. 1983

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To study the influence of non-coronary collateral blood circulation (NCCBC) on the integrity of the ischemic myocardium a right-sided thoracotomy was performed on 15 anesthetized dogs. Following a total cardiopulmonary bypass (CPB), ventricular fibrillation was induced, during which 2,000 ml calcium-free cardioplegic solution LK 352 was given at the aortic root over an 8-10 min period. Precautions were taken to prevent retrograde blood flow into the coronary system via the coronary sinus. After 90 min of ischemia, ten of the dog hearts were reperfused with systemic blood for the next 30 min. Transmural biopsies were taken from the apex of the left ventricle at the following intervals: (1) before CPB, (2) immediately after the infusion of LK 352, (3) following 90 min of ischemia, (4) after 5 min, (5) after 15 min, and finally (6) after 30 min of reperfusion and were then studied ultrastructurally. The presence of NCCBC was documented by the observation of erythrocyte-filled blood vessels in the biopsies corresponding to nos. 2 and 3 of the above. To assess the degree of ischemic injury and the extent of myocardial recovery during reperfusion, a scoring system based on a semiquantitative assessment of the characteristic morphological changes was used. The average result of the separately assessed subendo- and subepicardial layers represented the score, which was plotted on the ischemic injury and the recovery scale, thus making a direct comparison of the hearts possible. All the hearts generously supplied with blood via extracoronary routes during ischemia showed minimal and reversible ischemic injuries. They recovered more quickly and more completely following reperfusion than those hearts without NCCBC. From these results we conclude that despite its warming-up effect on the myocardium and its tendency to wash out the cardioplegic solution, the NCCBC generally protects the myocardium from serious ischemic injuries and shortens the period of recuperation during the reperfusion.

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Myocardial Management in Arterial Revascularization

Allen

Arterial Grafting for Coronary Artery Bypass Surgery

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Noncoronary Collateral Myocardial Blood Flow

Cited by 118 publications

References 20 publications

Blood Cardioplegia Serves as a Bicarbonate Donor to the Myocardium during Ischemia: Effects of Anoxia and Hypercapnia on Acid-Base Characteristics of Blood Cardioplegic Solution

Blood Cardioplegia Serves as a Bicarbonate Donor to the Myocardium during Ischemia: Effects of Anoxia and Hypercapnia on Acid-Base Characteristics of Blood Cardioplegic Solution

The influence of non-coronary collateral blood supply on the electively arrested heart during ischemia and reperfusion

Myocardial Management in Arterial Revascularization

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