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. 1972 Oct;51(10):2556–2565. doi: 10.1172/JCI107072

Myocardial Blood Flow in Man: Effects of Coronary Collateral Circulation and Coronary Artery Bypass Surgery

Sidney C Smith Jr 1,2,3, Richard Gorlin 1,2,3, Michael V Herman 1,2,3, Warren J Taylor 1,2,3, John J Collins Jr 1,2,3
PMCID: PMC332953  PMID: 5056655

Abstract

The effects of coronary artery bypass graft (CAB) and coronary collaterals (CC) on myocardial blood flow (MBF) were studied in 24 patients undergoing 29 CAB's. MBF after CAB was compared to preexisting MBF by intraoperatively injecting 133xenon via distal CAB with proximal CAB first occluded then open. Pressure gradients across bypassed obstructions were measured. The results were correlated with preoperative coronary arteriograms to determine the effects of CC on MBF and postobstructive perfusion pressures. Mean MBF was increased by CAB from 32±6 (se) ml/min per 100 g (CAB occluded) to 118±13 ml/min per 100 g (CAB open). The 133Xe clearance curves with CAB open were resolved into slow (19±2 ml/min per 100 g) and rapid (133±12 ml/min per 100 g) phases, suggesting that MBF remained heterogeneous after CAB. Vessels with less than 80% stenosis by angiography had pressure gradients less than 20 mm Hg across obstructions, high postobstructive perfusion pressures (75±7 mm Hg), and normal MBF (87±6 ml/min per 100 g) even with CAB occluded. Vessels with greater than 80% stenosis or total occlusion by angiography had significant pressure gradients with marked reduction of postobstructive MBF. No significant difference in postobstructive MBF was found when vessels with CC (21±4 ml/min per 100 g) were compared to those without CC (17±4 ml/min per 100 g) (P > 0.4).

These studies demonstrate that (a) mean MBF increased 268% after CAB, (b) heterogeneous MBF persisted after CAB, (c) CC were not associated with significant increases in MBF, and (d) vessels with less than 80% stenosis had less than 20 mm Hg gradient with minimal effect on resting MBF.

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Selected References

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

  1. Bassingthwaighte J. B., Strandell T., Donald D. E. Estimation of coronary blood flow by washout of diffusible indicators. Circ Res. 1968 Aug;23(2):259–278. doi: 10.1161/01.res.23.2.259. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. CONN H. L., Jr Equilibrium distribution of radioxenon in tissue: xenon-hemoglobin association curve. J Appl Physiol. 1961 Nov;16:1065–1070. doi: 10.1152/jappl.1961.16.6.1065. [DOI] [PubMed] [Google Scholar]
  3. Elliot E. C., Bloor C. M., Jones E. L., Mitchell W. J., Gregg D. E. Effect of controlled coronary occlusion on collateral circulation in conscious dogs. Am J Physiol. 1971 Apr;220(4):857–861. doi: 10.1152/ajplegacy.1971.220.4.857. [DOI] [PubMed] [Google Scholar]
  4. Field P., Trimble A. S., Trobridge G. F., Aldridge H. E. Direct myocardial revascularization: saphenous vein bypass grafts to the distal coronary artery. Technical details and postoperative hemodynamics. Ann Thorac Surg. 1970 Aug;10(2):112–118. doi: 10.1016/s0003-4975(10)65575-0. [DOI] [PubMed] [Google Scholar]
  5. Grondin C. M., Lepage G., Castonguay Y. R., Meere C., Grondin P. Aortocoronary bypass graft. Initial blood flow through the graft, and early postoperative patency. Circulation. 1971 Nov;44(5):815–819. doi: 10.1161/01.cir.44.5.815. [DOI] [PubMed] [Google Scholar]
  6. HERD J. A., HOLLENBERG M., THORBURN G. D., KOPALD H. H., BARGER A. C. Myocardial blood flow determined with krypton 85 in unanesthetized dogs. Am J Physiol. 1962 Jul;203:122–124. doi: 10.1152/ajplegacy.1962.203.1.122. [DOI] [PubMed] [Google Scholar]
  7. Helfant R. H., Kemp H. G., Gorlin R. Coronary atherosclerosis, coronary collaterals, and their relation to cardiac function. Ann Intern Med. 1970 Aug;73(2):189–193. doi: 10.7326/0003-4819-73-2-189. [DOI] [PubMed] [Google Scholar]
  8. Helfant R. H., Vokonas P. S., Gorlin R. Functional importance of the human coronary collateral circulation. N Engl J Med. 1971 Jun 10;284(23):1277–1281. doi: 10.1056/NEJM197106102842301. [DOI] [PubMed] [Google Scholar]
  9. Horwitz L. D., Gorlin R., Taylor W. J., Kemp H. G. Effects of nitroglycerin on regional myocardial blood flow in coronary artery disease. J Clin Invest. 1971 Aug;50(8):1578–1584. doi: 10.1172/JCI106645. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. JOHANSSON B., LINDER E., SEEMAN T. COLLATERAL BLOOD FLOW IN THE MYOCARDIUM OF DOGS MEASURED WITH KRYPTON. Acta Physiol Scand. 1964 Nov;62:263–270. doi: 10.1111/j.1748-1716.1964.tb03973.x. [DOI] [PubMed] [Google Scholar]
  11. Johnson W. D., Flemma R. J., Lepley D., Jr Direct coronary surgery utilizing multiple-vein bypass grafts. Ann Thorac Surg. 1970 May;9(5):436–444. doi: 10.1016/s0003-4975(10)65536-1. [DOI] [PubMed] [Google Scholar]
  12. Klocke F. J., Koberstein R. C., Pittman D. E., Bunnell I. L., Greene D. G., Rosing D. R. Effects of heterogeneous myocardial perfusion on coronary venous H2 desaturation curves and calculations of coronary flow. J Clin Invest. 1968 Dec;47(12):2711–2724. doi: 10.1172/JCI105954. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Mason D. T., Amsterdam E. A., Miller R. R., Hughes J. L., 3rd, Bonanno J. A., Iben A. B., Hurley E. J., Massumi R. A., Zelis R. Consideration of the therapeutic roles of pharmacologic agents, collateral circulation and saphenous vein bypass in coronary artery disease. Am J Cardiol. 1971 Nov;28(5):608–613. doi: 10.1016/0002-9149(71)90105-6. [DOI] [PubMed] [Google Scholar]
  14. ROSS R. S., UEDA K., LICHTLEN P. R., REES J. R. MEASUREMENT OF MYOCARDIAL BLOOD FLOW IN ANIMALS AND MAN BY SELECTIVE INJECTION OF RADIOACTIVE INERT GAS INTO THE CORONARY ARTERIES. Circ Res. 1964 Jul;15:28–41. doi: 10.1161/01.res.15.1.28. [DOI] [PubMed] [Google Scholar]
  15. Rees J. R., Redding V. J. Anastomotic blood flow in experimental myocardial infarction. A new method, using 133-Xenon clearance, for repeated measurements during recovery. Cardiovasc Res. 1967 Apr;1(2):169–178. doi: 10.1093/cvr/1.2.169. [DOI] [PubMed] [Google Scholar]
  16. Rees J. R. The myocardial collateral circulation. Br Heart J. 1969 Jan;31(1):1–4. doi: 10.1136/hrt.31.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Sheldon W. C. On the significance of coronary collaterals. Am J Cardiol. 1969 Sep;24(3):303–304. doi: 10.1016/0002-9149(69)90421-4. [DOI] [PubMed] [Google Scholar]

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