Skip to main content
British Heart Journal logoLink to British Heart Journal
. 1988 Feb;59(2):159–167. doi: 10.1136/hrt.59.2.159

Haemodynamic observations during percutaneous transluminal coronary angioplasty in the presence of synchronised diastolic coronary sinus retroperfusion.

K J Beatt 1, P W Serruys 1, P de Feyter 1, M van den Brand 1, P D Verdouw 1, P G Hugenholtz 1
PMCID: PMC1276978  PMID: 2963657

Abstract

Animal studies have demonstrated that synchronised coronary sinus retroperfusion with arterial blood can provide effective perfusion of ischaemic myocardium. Preliminary clinical studies have shown that the technique can also be used with safety in human beings, and in the present study its effectiveness was assessed in three patients undergoing repeated coronary artery occlusions during percutaneous transluminal coronary angioplasty. Arterial blood was removed via an 8F catheter positioned in the femoral artery and delivered by a retroperfusion pumping system to a 7F retroperfusion balloon catheter positioned in the anterior cardiac vein. Ischaemia-related indices were monitored both before and during coronary sinus retroperfusion. These indices included high fidelity left ventricular pressure recordings and pressure derived indices (including velocities of isovolumic contraction and relaxation), as well as electrocardiographic changes and symptoms. Analysis of these variables showed that the ischaemic changes induced during coronary artery occlusion were not prevented by this type of coronary sinus retroperfusion. There was no major complication in any of the patients. It may be that adaptation of the technique or the use of alternative end points will establish a benefit, but further modifications of the delivery system are necessary for effective clinical use.

Full text

PDF

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Carlson C. J., Ratajczyk-Pakalska E., Cogan J. J., Rapaport E. Effect of venous retroperfusion on experimental myocardial ischemia in the open-chest pig. J Surg Res. 1985 Feb;38(2):105–112. doi: 10.1016/0022-4804(85)90014-9. [DOI] [PubMed] [Google Scholar]
  2. Chang B. L., Drury J. K., Meerbaum S., Fishbein M. C., Whiting J. S., Corday E. Enhanced myocardial washout and retrograde blood delivery with synchronized retroperfusion during acute myocardial ischemia. J Am Coll Cardiol. 1987 May;9(5):1091–1098. doi: 10.1016/s0735-1097(87)80312-1. [DOI] [PubMed] [Google Scholar]
  3. Drury J. K., Yamazaki S., Fishbein M. C., Meerbaum S., Corday E. Synchronized diastolic coronary venous retroperfusion: results of a preclinical safety and efficacy study. J Am Coll Cardiol. 1985 Aug;6(2):328–335. doi: 10.1016/s0735-1097(85)80168-6. [DOI] [PubMed] [Google Scholar]
  4. Farcot J. C., Berdeaux A., Giudicelli J. F., Vilaine J. P., Bourdarias J. P. Diastolic synchronized retroperfusion versus reperfusion: effects on regional left ventricular function and myocardial blood flow during acute coronary occlusion in dogs. Am J Cardiol. 1983 May 1;51(8):1414–1421. doi: 10.1016/0002-9149(83)90322-3. [DOI] [PubMed] [Google Scholar]
  5. Friedman P. L., Shook T. L., Kirshenbaum J. M., Selwyn A. P., Ganz P. Value of the intracoronary electrocardiogram to monitor myocardial ischemia during percutaneous transluminal coronary angioplasty. Circulation. 1986 Aug;74(2):330–339. doi: 10.1161/01.cir.74.2.330. [DOI] [PubMed] [Google Scholar]
  6. Gallagher K. P., Kumada T., Koziol J. A., McKown M. D., Kemper W. S., Ross J., Jr Significance of regional wall thickening abnormalities relative to transmural myocardial perfusion in anesthetized dogs. Circulation. 1980 Dec;62(6):1266–1274. doi: 10.1161/01.cir.62.6.1266. [DOI] [PubMed] [Google Scholar]
  7. Gore J. M., Weiner B. H., Benotti J. R., Sloan K. M., Okike O. N., Cuénoud H. F., Gaca J. M., Alpert J. S., Dalen J. E. Preliminary experience with synchronized coronary sinus retroperfusion in humans. Circulation. 1986 Aug;74(2):381–388. doi: 10.1161/01.cir.74.2.381. [DOI] [PubMed] [Google Scholar]
  8. Meerbaum S., Lang T. W., Osher J. V., Hashimoto K., Lewis G. W., Feldstein C., Corday E. Diastolic retroperfusion of acutely ischemic myocardium. Am J Cardiol. 1976 Mar 31;37(4):588–598. doi: 10.1016/0002-9149(76)90400-8. [DOI] [PubMed] [Google Scholar]
  9. Mohl W., Punzengruber C., Moser M., Kenner T., Heimisch W., Haendchen R., Meerbaum S., Maurer G., Corday E. Effects of pressure-controlled intermittent coronary sinus occlusion on regional ischemic myocardial function. J Am Coll Cardiol. 1985 Apr;5(4):939–947. doi: 10.1016/s0735-1097(85)80437-x. [DOI] [PubMed] [Google Scholar]
  10. Mohl W., Roberts A. J. Coronary sinus retroperfusion and pressure-controlled intermittent coronary sinus occlusion (PICSO) for myocardial protection. Surg Clin North Am. 1985 Jun;65(3):477–495. doi: 10.1016/s0039-6109(16)43632-7. [DOI] [PubMed] [Google Scholar]
  11. Serruys P. W., Wijns W., van den Brand M., Meij S., Slager C., Schuurbiers J. C., Hugenholtz P. G., Brower R. W. Left ventricular performance, regional blood flow, wall motion, and lactate metabolism during transluminal angioplasty. Circulation. 1984 Jul;70(1):25–36. doi: 10.1161/01.cir.70.1.25. [DOI] [PubMed] [Google Scholar]
  12. Smith G. T., Geary G. G., Blanchard W., McNamara J. J. Reduction in infarct size by synchronized selective coronary venous retroperfusion of arterialized blood. Am J Cardiol. 1981 Dec;48(6):1064–1070. doi: 10.1016/0002-9149(81)90321-0. [DOI] [PubMed] [Google Scholar]
  13. Vincent G. M., Abildskov J. A., Burgess M. J. Mechanisms of ischemic ST-segment displacement. Evaluation by direct current recordings. Circulation. 1977 Oct;56(4 Pt 1):559–566. doi: 10.1161/01.cir.56.4.559. [DOI] [PubMed] [Google Scholar]
  14. Yamazaki S., Drury J. K., Meerbaum S., Corday E. Synchronized coronary venous retroperfusion: prompt improvement of left ventricular function in experimental myocardial ischemia. J Am Coll Cardiol. 1985 Mar;5(3):655–663. doi: 10.1016/s0735-1097(85)80391-0. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES