title: Selective arterialization of a cardiac vein in a model of cardiac microangiopathy and macroangiopathy in sheep.
abstract: OBJECTIVE
  Some patients with significant arteriosclerosis of the heart are not amenable to revascularization of a coronary artery because they have a combination of microangiopathy and significant macroangiopathy. We investigated the benefit of arterialization of a cardiac vein under these circumstances in an acute animal model.
  
  
  METHODS
  In the hearts of 8 sheep, microspheres were injected into the left coronary artery; 60 minutes later, a stenosis of the left anterior descending artery was performed. After 45 minutes, retrograde venous revascularization was performed by sewing the left internal thoracic artery to the concomitant vein of the left anterior descending artery in a beating-heart technique. For flow reversal, the vein was ligated proximally to the anastomosis. The efficiency of the bypass graft was evaluated by coronary angiography and flow measurement. Cardiac output, electrocardiography, and mean arterial blood pressure were assessed in each phase of the experiment.
  
  
  RESULTS
  The ischemic state of the myocardium was confirmed by a significant decrease of cardiac output, stroke volume, and mean arterial blood pressure, and a significant elevation of the ST segment in the electrocardiography. After retrograde venous revascularization was established, cardiac output and stroke volume increased and ST elevations decreased. The grafts showed adequate flow (26.15 +/- 2.08 mL/min), and reversed blood flow in the grafted vein was proved by coronary angiography.
  
  
  CONCLUSIONS
  Retrograde venous revascularization is possible and improves cardiac function in a state of acute ischemia caused by a combination of microangiopathy and macroangiopathy.
authors.affiliation: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany. michaela.resetar@med.uni-leipzig.de
authors.forename: Michaela Elisabeth
authors.initials: ME
authors.lastname: Resetar
authors.forename: Cris
authors.initials: C
authors.lastname: Ullmann
authors.forename: Petra
authors.initials: P
authors.lastname: Broeske
authors.forename: Kristin
authors.initials: K
authors.lastname: Ludwig-Schindler
authors.forename: Nicolas K
authors.initials: NK
authors.lastname: Doll
authors.forename: Aida
authors.initials: A
authors.lastname: Salameh
authors.forename: Stefan
authors.initials: S
authors.lastname: Dhein
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000818:Animals; D001794:Blood Pressure; D002302:Cardiac Output; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D008297:Male; D009204:Myocardial Revascularization / Q000379:methods*; D034561:Sheep, Domestic; D013318:Stroke Volume; D014680:Veins / Q000601:surgery
chemical_list: D003402:Creatine Kinase