The Coronary Sinus: Proceedings of the 1st International Symposium on Myocardial Protection via the Coronary Sinus PDF
Preview The Coronary Sinus: Proceedings of the 1st International Symposium on Myocardial Protection via the Coronary Sinus
The Coronary Sinus Printing of the proceedings of the First International Symposium on Myocardial Protection via the Coronary Sinus held in Vienna, February 27th-29th, 1984, is supported in part by grants from Abbott Laboratories and ~llJedl·tech. Incorporated. The Coronary Sinus Proceedings of the 1st International Symposium on Myocardial Protection via the Coronary Sinus Edited by W. Mohl, E. Wolner, D. Glogar With Contributions by M. Abbate, H. Abe, A. Aigner, C. S. Apstein, G. Arnold, W. G. Austen, J. Batanero, G. Battaglia, R. Bauer, A. Benassi, A. Berdeaux, J. Berland, W. Bircks, W. H. Bleifeld, A. Bodefeld, J.P. Bourdarias, M. J. Buckley, G. Bulkey, M. Bulves, L. Carli, A. Carpentier, A. Casale, N. Casinello, R. C. J. Chiu, A. A. Ciuffo, W. D. Coats, E. Corday, A. Cribier, H. F. Cuenoud, J. E. Dalen, M.A. D'Ambra, J. K. Drury, J. Fabian, J. N. Fabiani, J. C. Farcot, D.P. Faxon, M. C. Fishbein, M. Fuentes, E. Gallasch, J. Garcia, I. Gielchinsky, J. F. Giudicelli, D. Glogar, J. M. Gore, M. Goto, S. B. Gottsman, C. Groschopp, A. D. Guerci, S. R. Gundry, R. V. Haendchen, S. Hag!, H. Halperin, C. W. Hamm, W. Heimisch, C. F. M. Heintzberger, G. Hellige, 0. Hiramatsu, M. M. Hirsh, M. Hochberg, A. Hoeft, H. M. Hoffmeister, M. Hori, D. H. Hunneman, S.M. Hussain, M. Inoue, A. K. Jacobs, A. Juhasz-Nagy, M. Kagiyama, F. Kaindl, F. Kajiya, M. Kaminski, H. S. Karagueuzian, M.A. Kellett, T. Kenner, F. Kind!, W. Klepetko, G. S. Kobinia, K. Kodama, W. J. Kolff, H. Korb, Y. Koretsune, U. Kreimeier, H.-L. Kronholz, B. Krug, K. Kucharsky, W. Kupper, A. Lametschwandtner, P. J. LaRaia, I. Lengyel, B. Letac, D. Levantesi, M. J. Levesque, A. Lomeo, M. von Ludinghausen, A. Lunkenheimer, P. P. Lunkenheimer, G. Luppi, W. J. Mandel, P.R. Maroko, J. A. Martinez, M. Marzilli, G. Mattioli, G. Maurer, M. Mauser, S.M. McSweeney, H. Mayr, S. Meerbaum, N. Mendler, J. Merker, M. Mishima, K. Mito, M.G. Modena, W. Mohl, J. J. Moll, J. W. Moll, E. Moravcsik, A. Moritz, M. Moser, M. M. Muller, M. Naka, M. Nakai, S. Nanto, R. M. Nerem, J. C. Norman, Y. Ogasawara, M. Ohta, A. Papiewski, L. Papp, V. Parsonnet, L. Patane, T. Peter, M. B. Peterson, K. Podzuweit, U. Pott, C. J. Preusse, C. Punzengruber, G. Raberger, R. Rabinovits, E. Ratajczyk-Pakalska, J. Reiland, D. Robles, A. J. Roberts, T. J. Ryan, H. N. Sabbah, H. Schad, J. Schaper, W. Schaper, P. Schindler, G. Schopf, H. D. Schulte, J. Schuster, J. Schutz, R. Seitelberger, K. Sloan, K. A. Spector, P. D. Stein, Z. Szabo, S. Tadaoka, J. Tarnai, K. Taniura, W. Timischl, G. Tomonaga, M. Torres, M. Tschabitscher, K. Tsujioka, Y. Wada, J. Wagiel, P. J. Walter, W. D. Watkins, B. H. Weiner, M. L. Weisfeldt, L. Wetstein, T. Wiesner, M. Winkler,J. Winter, R. E. Winters, E. Wolner, H. G. Wolpers, S. Yamazaki, R. G. Zennaro, M. C. Zwolinski Springer-Verlag Berlin Heidelberg GmbH W. Mohl, M.D. E. Wolner, M.D. D. H. Glogar, M.D. 2nd Surgical Clinic 2nd Surgical Clinic Kardiologische U niversity of Vienna University ofVienna U niversitătsklinik Spitalgasse 23 Spitalgasse 23 Garnisongasse 13 1090 Vienna, Austria 1090 Vienna, Austria 1090 Vienna, Austria CIP-Kurztitelaufnahme der Deutschen Bibliothek The coronary sinus: proceedings of the Ist. Internat. Symposium on Myocardial Protection via the Coronary Sinus / ed. by W. Moh1 ... With contributions by M. Abbate ... ISBN 978-3-642-54129-2 ISBN 978-3-642-54127-8 (eBook) DOI 10.1007/978-3-642-54127-8 NE: Mohl, Werner [Hrsg.]; Abbate, M. [Mitverf.]; International Symposium on Myocardial Protec tion via the Coronary Sinus <01, 1984, Wien> This work is subject to copyright. Ali rights are reserved, whether the whole or part ofthe material is concerned, specifically those of translation, reprinting, re-use of illustrations, broadcasting, repoduc tion by photocopying machine or similar means, and storage in data banks. Under § 54 ofthe German Copyright Law, where copies are made for other than private use, a fee is payable to the publisher, the amount ofthe fee to be determined by agreement with the publisher. Copyright © 1984 by Springer-Verlag Berlin Heidelberg 0rigina11ypub1ished by Dr. Dietrich SteinkopffVerlag, GmbH & Co. KG, Darmstadt in 1984 Softcover reprint of the hardcover lst edition 1984 Editorial Assistance: J uliane K. Weller - Production: Heinz J. Schăfer The use ofregistered names, trademarks, etc. in this publication does not imp1y, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regu1ations and therefore free for general use. Type-Setting, printing and bookbinding: Vereinigte Buchdruckereien, Bad Buchau Preface The most common cause of death in the civilized countries remains coronary heart dis ease, a multifactorial illness which might be best treatable by prophylactic means. In spite of improvements in diagnosis, drug therapy, monitoring, and particularly surgery morbi dity and mortality of our patients oblige us to look for new frontiers in understanding the pathophysiology of the disease and for new approaches in the treatment of myocardial dysfunction, the limiting factor in the activity of patients surviving an acute myocardial infarction. Salvage of viable myocardium still seems to be the most important challenge in the treatment of acute ischemia. Lysis therapy to reopen occluded coronary arteries seems to be promising in a great number of patients. However, several experimental re ports of reperfusion injury and clinical series with a considerable number of patients, who do not benefit from this intervention, need alternatives to reassess myocardial structure and function. The necessity to find solutions to this problem coincides with the develop ment of an alternate access route to deprived coronary vasculature. Starting with the ideas and results gathered in the last 60 years, Meerbaum and Corday in Los Angeles and our group here in Vienna developed two different approaches to myocardial protection via the coronary sinus. After completing experimental evaluation and preliminary human trials it is now time to draw the attention of the scientific community, as well as the prac tising cardiologist and cardiovascular surgeon, to interventions such as synchronized ret roperfusion or pressure controlled intermittent coronary sinus occlusion and retrograde cardioplegia delivery during open heart surgery. This volume will present the proceedings of the I st International Symposium of Myocardial Protection via the Coronary Sinus held in Vienna, February 27 till29, 1984. The motivation to call for this convention was to bring this rapidly developing subject to experts of related areas to guarantee a multidis ciplinary evaluation of new therapeutic interventions. Since our knowledge of the basics of the coronary venous system has to be developed we included the experience of anato mists, physiologists, and even bioengineers for a synthesis of the available background in formation. It is the aim of this book to identify what is known about the coronary venous system, what is controversial, what we think about interventions such as retroperfusion or intermittent coronary sinus occlusion, and which areas merit further study. The clini cal entity of Beck's procedure particularly intrigued me, and eventually led me back to the animal laboratory and the development of pressure controlled intermittent coronary sinus occlusion. Therefore this book is dedicated to those who find special interest in pro posed ideas and fulfill speculations so that research interests with many nuances become formidable tasks and finally add to the puzzle of understanding the pathophysiology of the heart. Vienna, May 15, 1984 W. Mohl v Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . V Part A: Coronary Sinus: Fundamentals Anatomy Nomenclature: Venae cardiacae-cardiac veins Liidinghausen M von, Ratajczyk-Pakalska E, Tschabitscher M, Maurer G, Glogar D, Mohl W .........................· ............................... . Anatomy of the Coronary Arteries and Veins Liidinghausen M von . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Anatomy of Coronary Veins Tschabitscher M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 The Microcirculatory Vascular Bed of the Dog's Heart. A Scanning Electron Microscopy Study of Vascular Corrosion Casts Lametschwandtner A, Mohl W . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Automated Image Analysis for Measurement of Area of the Smallest Cardiac Veins in Ventricular Myocardium Ratajczyk-Pakalska E, Wagiel J, Kaminski M, KolffWJ . . . . . . . . . . . . . . . . . . . . . . . . . 33 Anatomical Basis for the Coronary Venous Outflow Ratajczyk-Pakalska E, KolffWJ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 The Vascularization Pattern in the Ventricular Wall in Different Species During Development Heintz berger ChFM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 7 Functional Anatomy of the Coronary Sinusoids Lunkenheimer A, Merker J, Lunkenheimer PP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Dynamics of the Coronary Circulation Wave Reflection and Pressure Flow Relations in the Coronary Circulation Kenner T, Moser M, Mohl W . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Fluid Dynamics in Proximal and Distal Coronary Artery Measured by Laser Doppler Velocimeter Kajiya F, Tsujioka K, Tomonaga G, Ogasawara Y, Tadaoka S, Goto M, Wada Y, Kagiyama M, Mito K . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Dynamic Characteristics of Diastolic Pressure - Flow Relation in the Canine Coronary Artery Tomonaga G, Tsujioka K, Ogasawara Y, Nakai M, Mito K, Hiramatsu 0, Kajiya F 79 VI Coronary Fluid Dynamics Nerem RM, Levesque MJ, Rabinovitz R, Wiesner T . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Determinants of Cardiac Pump Efficiency. Comparison of a Theoretical Model with Experimental Data of Normo-and Hypothermic Dogs Hoeft A, Korb H, Wolpers HG, Hellige G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Origin of Phasic Coronary Venous Flow and the Capacitance of Intramyocardial Coronary Vein Tsujioka K, Tornonaga G, Ogasawara Y, Nakai M, Tadaoka S, Goto M, Kajiya F .. 100 Determination of Myocardial Blood Flow with Transcoronary Dye Dilution Hoeft A, Korb H, Wolpers HG, Hellige G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 lntramyocardial Pressure Dynamics Diastolic Distribution oflntramural Pressure in the Canine Left Ventricle Marzilli M, Sabbah HN, Levantesi D, Stein PD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Is lntramyocardial Pressure Measurable? Kreirneier U . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Cardiodynamics Governed by Intramyocardial Hydraulics Lunkenheirner A, Lunkenheirner PP, Kronholz HL, Schutz J . . . . . . . . . . . . . . . . . . . . 125 Pathophysiology of Ischemia and Reperfusion Purine Metabolism of the Heart Muller MM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Sustained Anaerobic Metabolism After Recanalization of Coronary Artery in Acute Myocardial Infarction Nanto S, Kodama K, Naka M, Taniura K, Tarnai J, Koretsune Y, Hori M, Inoue M . 142 Failure of Postischemic ATP Repletion by Adenosine to Improve Regional Myocardial Function Hoffmeister HM, Mauser M, Schaper W . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 Metabolic Changes of Glucose, Lactate and Free Fatty Acids During Ischemia and Subsequent Reperfusion Korb H, Hoeft A, Hunnernan DH, Wolpers HG, Hellige G . . . . . . . . . . . . . . . . . . . . . . . 153 Oxygen-Debt and -Repayment in the Early Phase of Myocardial Ischemia Korb H, Hoeft A, Wolpers HG, Hellige G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 Penetration of Coronary Venous Injections into Ischemic Myocardium Maurer G, Punzengruber C, Haendchen RV, Torres MAR, Meerbaurn S, Corday E . 16 7 The Evaluation of Collateral Function by Contrast Medium-Induced Hyperemia Koretsune Y, Hori M, Inoue M, Kodama K, Nanto S, Mishirna M, Abe H . . . . . . . . . 176 Quantitative Assessment of Collateral Flow in Patients with Ischemic Heart Disease Kupper W, Harnrn CW, Bleifeld WH......................................... 182 VII Left Main Coronary Artery Stenosis: Evaluation by Coronary Sinus Blood Flow, Lactate Metabolism and Holter Monitoring Hamm CW, Kupper W, Bleifeld W . . . .. .. . . . . . . . . . .. .. . . . .. .. .. . . . . . . . . . .. .. . 188 Myocardial Protection, Complex Laboratory Examinations and their Computerized Evaluation Lengyel I, Szabo Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 Acute Myocardial Ischemic Reduction with Ibuprofen in the Isolated Perfused Rabbit Heart Wetstein L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 Effect of Dipyridamole on Coronary Flow; A Thermodilution Study of the Coronary Reserve Berland J, Cribier A, Letac B .. .. .. . . . . . . . .. .. .. .. .. .. . .. . . . .. .. .. .. . . . . . . . . . 212 Coronary Blood Flow Modifications After Administration of Captopril Mattioli G, Zennaro G, Benassi A, Modena MG, Luppi G . . . . . . . . . . . . . . . . . . . . . . . 221 Cold Pressor Test, Incremental Cardiac Pacing, Coronary Hemodynamics and Coronary Sinus Blood Rheology in Patients with Angina Pectoris and Normal Coronary Angiogram Fabian J, Bulvas M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 Pathophysiology of Venous and Lymph Obstruction Hemodynamic Pattern of Cardiodepression Elicitable from Reflexogenic Areas in Left Coronary Venous System of the Dog Juhasz-Nagy A, SzabO Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231 Present Knowledge of the Effects of Experimental Cardiac Lymphatic Obstruction Schad H .................................................................. 239 Part B: Myocardial Protection via the Coronary Sinus Delivery of Cardioplegic Solution An Overview of Myocardial Protection in Open-heart Surgery Roberts AJ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 7 Cardiac Prostacyclin Metabolism During Canine Cardiopulmonary Bypass Kobinia GS, LaRaia PJ, D'Ambra MA, Peterson MB, Watkins WD, Buckley MJ, Austen WG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259 Thermographic Evaluation of Retrograde Cardioplegia: Experimental and Clinical Studies Moravcsik E, Papp L, Lengyel I, SzabO Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266 Myocardial Compliance Following Retrograde Versus Antegrade Cardioplegia in the Presence of Coronary Artery Obstmction Gundry SR, Kirsh MM ..................................................... 270 VIII Cold Cardioplegia via Retrograde Coronary Sinus Infusion for Myocardial Protection Chiu RCJ................................................................. 275 Metabolic and Ultrastructural Changes in the Ischemic Human Myocardium due to Additional Perfusion of the Coronary Sinus with "Bretschneider Cardioplegic Solution" Walter PJ, Kindl F, Podzuweit K, Schaper J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284 Myocardial Equilibration Aspects of Ante-and Retrograde Crystalloid Cardioplegic Perfusion Preusse CJ, Winter J, Krug B, Schulte HD, Arnold G, Bircks W ................. 291 Coronary Venous Blood Parameters During Postischemic Reperfusion After Mitral Valve Replacement Schulte HD, Preusse CJ, Bodefeld A, Groschopp C, Pott U ..................... 297 Myocardial Protection via the Coronary Sinus in Cardiac Surgery: Comparative Evaluation of Two Techniques Fabiani JN, Reiland J, Carpentier A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305 Myocardial Protection: Antegrade versus Retrograde Cardioplegia, a Clinical Trial on 145 Patients Lomeo A, Battaglia G, Carli L, Patane L, Abbate M . . . . . . . . . . . . . . . . . . . . . . . . . . . 312 Cardioplegia via the Coronary Sinus. Our Experience in 331 Cases Fuentes M, Batanero J, Robles D, Martinez JA, Garcia J, Casinello N............ 316 Retroperfusion Modalities The Beck Era: A Springboard for Renewed Research of Coronary Venous Retroperfusion Aimed at Treatment of Myocardial Ischemia Meerbaum S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320 a) Selective Arterialization of Coronary Veins Arterialization of the Left Anterior Descending Coronary Vein in Dogs: Successful Long-Term Flow Evaluation Hochberg MS, Gielchinsky I, Parsonnet V, Hussain SM, Norman JC . . . . . . . . . . . . . 328 Selective Arterialization of the Coronary Venous System Under Low Pressure Moll JJ, Moll JW, Zwolinski MC, Kucharski K, Papiewski A, Maroko PR . . . . . . . . 336 b) Synchronized Retroperfusion Fundamental Consideration of Synchronized Coronary Venous Retroperfusion: an Alternate Vascular Channel for Protection of Jeopardized Ischemic Myocardium Corday E, Meerbaum S, Drury JK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343 Synchronized Coronary Venous Retroperfusion: A Safe and Effective Treatment of Acute Myocardial Ischemia Drury JK, Yamazaki S, Meerbaum S, Fishbein M, Corday E . . . . . . . . . . . . . . . . . . . . 347 IX
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