Coronary veins: an alternate route to ischemic myocardium.
Acute myocardial ischemia is the primary cause of concern during myocardial infarction and unstable angina, and the cornerstone of modern therapy is rapid establishment of antegrade blood flow. The ultimate success of reperfusion depends on the duration and severity of ischemia before revascularization. Even brief ischemia occurring during angioplasty may cause reversible myocardial dysfunction. Several interventions are available to minimize the negative effects of acute myocardial ischemia. Synchronized coronary venous retroperfusion is a myocardial support technique in which autologous arterial blood is shunted from the femoral artery into the ischemic myocardium via the coronary sinus. Retroperfusion has been studied clinically during angioplasty and has been shown to ameliorate and delay the onset of ischemia. It has also been beneficial during abrupt closure of the coronary artery after angioplasty as a bridge to definitive therapy. Preliminary reports have indicated the efficacy of retroperfusion in medically refractory unstable angina. Because of its retrograde approach, this technique may serve as an alternate route to an otherwise inaccessible, ischemic myocardium for delivery of blood and other cardioprotective agents.
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Cedars-Sinai Medical Center, Los Angeles, Calif. 90048.
Nordlander
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D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000150:complications / Q000628:therapy*; D003331:Coronary Vessels / Q000033:anatomy & histology; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy; D015425:Myocardial Reperfusion / Q000295:instrumentation