Myocardial protection via coronary sinus interventions: superior effects of arterialization compared with intermittent occlusion.

Abstract

It has been reported that infarct size can be reduced by several interventions, by which arterial blood is delivered retrogradely to the ischemic myocardium through the cardiac veins or alternatively the cardiac venous system is intermittently occluded. Accordingly, we studied several modalities of myocardial protection that used the cardiac venous system and compared them by means of a quantitative technique for measuring infarct size. Thus 73 anesthetized dogs with coronary arterial occlusion were randomized into the following groups: group I (n = 9), 6 hr of occlusion without any intervention; group II (n = 11), venovenous shunt (60 ml/min) to the great cardiac vein; group III (n = 11), arteriovenous shunt to the anterior interventricular vein; group IV (n = 12), high flow arteriovenous shunt to the anterior interventricular vein (60 ml/min); group V (n = 11), arteriovenous shunt to the great cardiac vein (60 ml/min); group VI (n = 10), arteriovenous shunt to the great cardiac vein (60 ml/min) combined with diastolic occlusion of the great cardiac vein; group VII (n = 9), intermittent pressure-controlled occlusion of the great cardiac vein without arterialization. The arteriovenous shunt (groups III to VI) or venovenous shunt (group II) was done by selective catheterization of the anterior interventricular vein or the great cardiac vein, advancing a catheter from the jugular vein through the right atrium and coronary sinus under fluoroscopic control. This catheter was then connected to a cannula located either in the carotid artery (groups III to VI) or in the right atrium (group II). One minute after occlusion, 99mTc-labeled albumin microspheres (8 mCi) were injected into the left atrium for the subsequent assessment of the hypoperfused zone, which is the area at risk for infarction.(ABSTRACT TRUNCATED AT 250 WORDS)