Chapter category: Heart
Coronary Venous Interventions (Experimental Clinical Studies)
Coronary Sinus Intervention in Cardiac Surgery, Second Edition
Edited by: Werner MohlISBN: 1-58706-006-X
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Chapter authors:
Samuel Meerbaum
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The thrust of advances in interventional cardiology has been aimed at treatment of myocardial jeopardy associated with coronary insufficiency. With surgical coronary artery bypass firmly established, the clinical armamentarium was more recently enriched by thrombolytic reperfusion to combat acute myocardial infarction and various modes of angioplasty to reverse the consequences of significant coronary artery obstructions.
With an ever increasing number of antegrade coronary interventions, including thrombolysis and percutaneous transluminal coronary (PTCA), being applied in high risk settings, serious consideration had to be given to protective support in case of marginal effectiveness, intolerable transient ischemia, or intervention failure leading to persistent coronary occlusion. In the latter situations, it may be essential to at least temporarily maintain the viability of jeopardized myocardium, pending revascularization.
Among antegrade support techniques, perfusion through special PTCA balloon catheters was shown to improve myocardial oxygen supply and to permit extended balloon inflations. This effective approach has a few disadvantages, e.g., a larger profile limiting catheter maneuvering and balloon positioning in small or torturous vessels and potential interference with perfusion at coronary branches. A systemic support, e.g., intraaortic balloon counterpulsation, newer hemopumps or percutaneous cardiopulmonary bypass may be applied during interventions in high risk settings, which could otherwise lead to hemodynamic decompensation, cardiogenic shock, refractory arrhythmias and even cardiac arrest.
Additional chapters from this book:
Coronary Venous Retroinfusion During Interventional Cardiology
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During the past decade, several percutaneous support devices for coronary angioplasty have been developed with the aim of improving myocardial tolerance to ischemia, thereby increasing the ...
Coronary Sinus Interventions in Experimental Research: A Review
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Despite optimal myocardial protection, ventricular dysfunction may still occur in the postoperative period following the revascularization of acutely ischemic myocardium. As more high risk pat...
Coronary Venous Interventions (Experimental Clinical Studies)
Samuel Meerbaum
The thrust of advances in interventional cardiology has been aimed at treatment of myocardial jeopardy associated with coronary insufficiency. With surgical coronary artery bypass firmly es...
Coronary Sinus Interventions During Surgical Treatment of Acute Myocardial
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The coronary venous connections to the capillary bed of the heart have been described for nearly 100 years,1 yet it was not until the 1940s that clinical application of this concept...
The Selection of Antegrade Versus Retrograde Cardioplegia Delivery
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The optimal delivery of cardioplegia to induce and maintain cardiac arrest is fundamen-tal to myocardial preservation during cardiac surgery. Traditional approaches utilizing intracoronary ...
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Previously published clinical series do not reflect the evolution of myocardial protection, anesthetic, and surgical revascularization techniques. Despite the relentless progressive increase i...
The Hazards of Ischemia/Reperfusion Injury During Revascularization
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Enormous advances in surgical, pharmacological, and interventional techniques result-ing in early restoration of infarct artery patency significantly improved outcome in patients with acute co...
Computer Simulation and Modeling of the Coronary Circulation
Friederike Neumann, Martin Neumann, Rudolf Karch, and Wolfgang Schreiner
In the large field of physiological processes such as, for instance, transportation and delivery of substances in the circulatory systems of the body, computer experiments and simulation st...
Regional Differences and Variability in Left Ventricular Wall Motion
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In our understanding of the mechanical performance of the heart as a pump we mostly rely on the famous studies of Otto Frank1 and Ernest Starling2 whose observations h...
Structure and Function of the Cardiac Lymphatic System
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The physiology of the lymphatic system lives like Cinderella at the side of her attractive sisters the physiology of the heart and of the circulation. Lymphatic vessels, however, have been ...
The Anatomical Basis of Coronary Sinus Reperfusion
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The venous drainage system of the myocardium is divided in two parts (Fig. 1):
A. The great (major) cardiac venous drainage system (GCVDS) extends over the surface of the ventricul...
The Venous Drainage of the Myocardium in the Human Heart
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The coronary sinus (cs) is the anatomically appropriate location for the placement of a balloon catheter for retrograde perfusion or revascularization, in particular of the vessels of the l...
Development of Blood Cardioplegia and Retrograde Techniques, The Experimenter/Observer Complex
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A surgical colleague, Dr. Mohl, asked me to describe the course of develop-ments in myocardial protection coming from our studies during the past 28 years, as all seems to flow logically. S...
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Thank God for the ingenious device of coronary ventricular channels, which relieve the myocardium from the coronary blood and thus prevent accumulations of interstit...
