Enhancement of noncoronary collateral circulation: the hypothesis of an alternative treatment for ischemic heart disease.
The internal thoracic arteries (ITAs) are a source of "noncoronary collateral circulation" (NCCC), or "noncoronary collateral blood flow" (NCCBF). The hypothesis herein is that enhancement of NCCC may represent an alternative means of myocardial blood supply: (1) Ligature of the ITAs creates a local hypertensive status and increases the perfusion pressure within the channels leading to the heart; (2) Myocardial ischemic stimulus diverts most ITA-related collateral flow to the heart rather than to the chest wall; (3) The ITAs may develop neo-collaterals owing to their ischemia-related plastic potential; (4) Angiogenic growth factor administration within the ITAs enhances neo-collateral development. These elements may pave the way for a new field of cardiovascular research aimed at enhancing NCCC as a new therapeutic option for ischemic heart disease.
Picichè
Marco
M
Cardiac Surgery Department, Laval University Hospital, Québec City, Québec, Canada. marco.piciche@libero.it
Kingma
John G
JG
Fadel
Elie
E
Dagenais
Francois
F
Robillard
Justin
J
Simard
Denis
D
Voisine
Pierre
P
D003097:Collateral Circulation; D003326:Coronary Circulation; D006321:Heart / Q000503:physiopathology; D006801:Humans; D006973:Hypertension; D036341:Intercellular Signaling Peptides and Proteins; D008962:Models, Theoretical; D017202:Myocardial Ischemia / Q000503:physiopathology* / Q000628:therapy*; D009206:Myocardium / Q000473:pathology; D018919:Neovascularization, Physiologic
D036341:Intercellular Signaling Peptides and Proteins