Circulation, Vol 86, 1265-1279, Copyright © 1992 by American Heart Association
BH Oh, M Volpini, M Kambayashi, K Murata, HA Rockman, GS Kassab and J Ross Jr
BACKGROUND. The degree of recovery of regional myocardial contraction
during coronary venous retroperfusion has not been well established,
particularly in the absence of coronary collateral channels. Therefore, the
maximal functional benefit attainable with coronary venous retroperfusion
was assessed in pigs by means of using selective pump retroperfusion of the
left anterior descending vein, with venting of the left anterior descending
artery to zero pressure. METHODS AND RESULTS. In eight anesthetized
open-chest pigs during selective left anterior descending venous
retroperfusion over a range of retroperfusion flows, regional myocardial
function (percent systolic wall thickening by sonomicrometry) increased
progressively to an average of 62% of control values at a retroperfusion
flow rate 200% of control arterial flow. Progressive thickening of the
end-diastolic dimension of the anterior wall was observed with increasing
retroperfusion flow (from 8.7 +/- 0.9 to 10.7 +/- 2.3 mm, p less than
0.001). Perfusion pressures within the left anterior descending vein
increased linearly with increased retroperfusion flow rates (up to 132 +/-
57 mm Hg with retroperfusion flow 200% of control). A gradual increase of
retrograde left anterior descending arterial outflow was observed with
increasing retroperfusion flows; however, the absolute amount (maximum, 8.3
+/- 4.1 ml/min) was much too low to explain the extent of functional
recovery. Transmural myocardial capillary blood flows in the anterior wall
with retroperfusion flows of 100% and 200% of control arterial flow were
0.22 and 0.42 ml/min/g with corresponding subendocardial blood flows of
0.14 and 0.29 ml/min/g; ratios of endocardium to epicardium were 0.51 and
0.61, respectively. Thus, capillary blood flows during selective
retroperfusion were relatively low despite considerable restoration of
regional systolic wall thickening, and a significant difference was noted
in the slopes of the relations between regional systolic wall thickening
and myocardial blood flow during retroperfusion and anterograde arterial
perfusion (p less than 0.05). With retrograde injection of silicone
elastomer at different retroperfusion pressures (50, 75, and 100 mm Hg) in
three pigs, capillaries were well visualized, and profuse intramyocardial
venous anastomotic connections were seen at the highest retroperfusion
pressure (100 mm Hg), whereas there was filling of small venules but little
capillary filling at the lowest retroperfusion pressure (50 mm Hg).
CONCLUSIONS. Considerable recovery of regional myocardial function with low
regional capillary blood flows were observed during acute venous
retroperfusion with high retroperfusion flows with arterial blood. These
findings together with low levels of retrograde arterial outflow and
visualization of retrograde capillary filling with a rich venous network
provide evidence for possible oxygen delivery via the intramyocardial
venous plexus.
ARTICLES
Myocardial function and transmural blood flow during coronary venous retroperfusion in pigs
Department of Medicine, University of California San Diego, La Jolla 92093-0613.
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