31.01.10 01:00 Age: 13 yrs

The heart needs oxygen in deprived areas, it is not that simple!

Please have a look at Professor Mohl's eLetter regarding the article "Coronary venous retroperfusion: an old concept, a new approach" from Kassab et all published in the Journal of Applied Physiology

(link to the original article)

It is well known from numerous observations, that oxygenated blood is not entering the deprived microcirculation during myocardial infarction and retroperfusion of arterial blood(1). Otherwise salvage would be most extensive around epicardial veins and not in border zones. As indicated by us activation of venous endothelium seems to be the most important factor in a complex mechanical and molecular network which is apparently also able to induce long term effects in humans by changing even the pattern of antiatherosclerotic molecules (2,3). Deciphering the causal relationship of improvements as well as knowing the restrictions of coronary sinus interventions seem to be an important scientific challenge since application of these concepts in current therapy of myocardial infarction has to be timed and individually adapted to allow best practice. So Kassab is right in postulating that "what the heart needs is oxygen", but we have to understand that not all (obvious) pathways lead to success. In one of our very early studies we measured oxygen in the ischemic area with electrodes however we were unable to get a significant increase in the center of the deprived area although myoglobin showed an oxygenated signal. Perhaps this experiment should be reconsidered with the autoperfusion technique to solve the question once and forever whether oxygen can be delivered to ischemic regions under these circumstances or that other more complex mechanisms apply in obvious improvements induced by coronary sinus manipulations.

1)Mohl W, Mina S, Milasinovic D, Kasahara H, Wei S. The legacy of coronary sinus interventions: endogenous cardioprotection and regeneration beyond stem cell research. J Thorac Cardiovasc Surg 2008;136:1131-1135 2)Mohl W, Mina S, Milasinovic D, Kasahara H, Wei S, Maurer G. Is activation of coronary venous cells the key to cardiac regeneration? Nat Clin Pract Cardiovasc Med 2008;5:528-530. 3)Mohl W, Komamura K, Kasahara H, Heinze G, Glogar D, Hirayama A, et al. Myocardial protection via the coronary sinus. Circ J 2008;72:526-533.