Preliminary experience with synchronized coronary sinus retroperfusion in humans.

Gore, Joel M.; Weiner, Bonnie H.; Benotti, Joseph R.; Sloan, K. M.; Okike, O. N.; Cuénoud, Henri F.; Gaca, J. M. J.; Alpert, J. S.; Dalen, James E.

doi:10.1161/01.cir.74.2.381

Cited by 58 publications

(9 citation statements)

References 16 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%

“…34,35 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. 33,35,36 Finally, SRP has been found to preserve myocardial viability and limit experimentally induced infarct size.…”

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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“…Synchronized retrograde perfusion (SRP) of autologous arterial blood via the coronary venous system has been shown to ameliorate ischemia in various clinical settings including support of coronary angioplasty, treatment of unstable angina, and acute myocardial infarction [1][2][3][4][5][6][7]. Original discussions regarding retroperfusion advocated the possible use of this technique in hospitals without cardiac catheterization laboratory or coronary angioplasty capability [8].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 1993

Cathet. Cardiovasc. Diagn.

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Synchronized coronary venous retroperfusion of autologous arterial blood was offered to patients referred for medically refractory unstable angina or evolving myocardial infarction with contraindications to thrombolytic therapy. Primary endpoints of angina, ST segment deviation, and two-dimensional echocardiographic systolic wall motion were followed to determine the efficacy of retroperfusion in patients prior to and then during angioplasty, surgical intervention, or pharmacological management, as the clinical picture warranted. Over a 12 month period, 21 patients were referred and 15 received retroperfusion. All experienced full relief of angina (p = 0.008). ST segment deviations and systolic wall motion of ischemic zones were observed to improve (p = 0.06 ST changes; p = 0.0001 wall motion changes) with synchronized retrograde perfusion. During attempts to remove patients from retroperfusion, statistically significant (p < 0.01) reproducible changes in these same endpoints were documented. Retroperfusion appears to improve acute myocardial ischemia. This technique functions well in the intensive care unit environment with only fluoroscopy as technical imaging support.

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“…Reports of a new technique for the reversal of myocardial ischemia using arterial blood pumped retrogradely into the coronary sinus (coronary venous retroperfusion) have suggested that it is safe and effective. 7 - 8 We have adapted this technique for the rescue of ischemic brain.…”

mentioning

confidence: 99%

“…In 1986, clinical retroperfusion studies were begun in patients experiencing unstable angina 7 and during percutaneous transluminal coronary angioplasty. 8 In both reports, retroperfusion reduced the frequency of anginal episodes.…”

mentioning

confidence: 99%

Ischemic brain rescue by transvenous perfusion in baboons with venous sinus occlusion.

Frazee¹,

Jordan²,

Dion³

et al. 1990

Stroke

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We studied brain retroperfusion in nine adult baboons. Experiments in four baboons determined techniques and the safety of retroperfusion, and experiments in three baboons determined the ability of retroperfusion to reverse cerebral ischemia. Two baboons died before retroperfusion. Arterial blood was continuously circulated by an external pumping system from one femoral artery into the intracranial sinuses through specially designed balloon-tipped catheters placed percutaneously into the sigmoid sinuses bilaterally.

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Preliminary experience with synchronized coronary sinus retroperfusion in humans.

Cited by 58 publications

References 16 publications

Trans-Coronary-Venous Interventions

Trans-Coronary-Venous Interventions

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

Ischemic brain rescue by transvenous perfusion in baboons with venous sinus occlusion.

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