Shunt between the ventricular chamber and coronary arteries preserves left ventricular function in acute myocardial infarction.
It is controversial whether newly created channels made by transmyocardial laser revascularization are functionally significant, so the present study evaluated the shunt flow from the left ventricular (LV) cavity to the ischemic myocardium in 51 patients with acute myocardial infarction (AMI) caused by complete occlusion of the proximal left anterior descending coronary artery. All patients underwent left heart catheterization within 24 h of onset and all underwent successful coronary reperfusion using primary coronary angioplasty with no angiographic restenosis on follow-up coronary angiography (CAG). The presence of the LV shunt flow was evaluated by selective left CAG after successful reperfusion. The LV global ejection fraction (EF) and regional function (centerline method) were analyzed by ventriculography in both the acute and chronic phases. The patients were divided into the 3 groups (Group A, no LV shunt without collaterals, n=20; Group B, no LV shunt with collaterals, n=24; Group C, LV shunt with collaterals, n=7). There was no difference in the grade of collateral circulation between Groups B and C. The improvements in LVEF and regional function from the acute phase to the chronic phase were significantly greater in Group C than in Groups A and B. Not only collateral circulation but also LV shunt contributes to the functional recovery of infarct myocardium in patients with AMI.
Miyamoto
Shoichi
S
Department of Cardiovascular Medicine, Kyoto University, Graduate School of Medicine, Japan.
Fujita
Masatoshi
M
Ueda
Kinzo
K
Tamaki
Shun-ichi
S
Hasegawa
Koji
K
Nagaya
Noritoshi
N
Sasayama
Shigetake
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D003097:Collateral Circulation; D003331:Coronary Vessels / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006334:Heart Function Tests; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000601:surgery*; D015425:Myocardial Reperfusion; D009204:Myocardial Revascularization / Q000379:methods; D012039:Regional Blood Flow; D016277:Ventricular Function, Left