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21.11.08 18:07 Age: 9 yrs

Simplified Coronary Sinus Retroperfusion





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Introduction

Acute coronary occlusion is an emergent situation because any delay for treatment may result in sudden loss of myocardial contractility due to insufficient blood supply to the tissues. In some cases, sudden resumption of antegrade blood flow may take time adversely affects the myocardial function. Therefore retrograde coronary perfusion is a method to protect the acutely ischemic myocardium in the very early period of ischemia (1). This method has been used with varying degree of success in various studies but has not been accepted as a technique for widespread clinical use. Utilization of this method requires some sophisticated devices increasing the cost of this method ands limits its widespread use. Because of this reason in our studies, we described a simplified technique for retrograde perfusion (2-4). This method is simply based on a hollow line making a connection between aorta and coronary sinus. Our experimental studies showed that this simple technique is effective for myocardial protection during acute coronary artery occlusion. In this brief report we will summarize our results.

Material and methods
After the anesthesia, thorax was opened and Left anterior descending artery was prepared for this experimental procedure. This artery was encircled with a silk suture. After this procedure, a retrograde canula was inserted to the coronary sinus another catheter was put on the aorta. By using a line, aorta coronary sinus connection was established (picture 1). After occluding the left anterior descending artery, aorto coronary sinus circulation was initiated and myocardial part of coronary arteries blood supply were established via retrograde root.

Results
Our sequential studies showed that perfusion of the heart via retrograde perfusion protect the myocardium from the adverse effects of acute coronary occlusion. Cardiac output and related parameters are improved significantly. Left ventricular stroke work and pulmonary capillary wedge pressure relationship improved significantly. In parallel with these changes myocardial infarct size was reduced significantly with resultant improved myocardial recovery (5).

Discussion
In these studies, we were able to show that myocardial tissue may be preserved via retrograde coronary sinus perfusion. Retrograde coronary sinus perfusion improves the myocardial perfusion and nourishes the acutely ischemic myocardium. This type of treatment is the way of reducing acute myocardial injury. On the other hand enrichment of retrograde perfusion with some additives such as iloprost, carnitine and other drugs improves the myocardial perfusion better than the simple myocardial perfusion alone (6-8). As a result of our studies we concluded that myocardial perfusion improves the myocardial hemodynamia. Our sequential studies showed that simplified coronary sinus retroperfusion may be effective during the beating heart surgery, coronary angioplasty, and in all cases during the acute coronary occlusion.


References