Clinical application of coronary sinus retroperfusion during high risk percutaneous transluminal coronary angioplasty
| Autor: | Robert L. Incorvati, Michael J. Pecora, Bryan C. Donohue, Stuart G. Tauberg, Sinda B. Dianzumba, Mitchell W. Krucoff, Robin S. Macherey |
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| Rok vydání: | 1993 |
| Předmět: |
Adult
Male Cardiac Catheterization medicine.medical_specialty medicine.medical_treatment Myocardial Ischemia Ischemia Hemodynamics Coronary Disease Myocardial Reperfusion Balloon Electrocardiography Risk Factors Internal medicine Angioplasty medicine Humans ST segment Angioplasty Balloon Coronary Coronary sinus Aged Aged 80 and over business.industry Middle Aged medicine.disease Coronary Vessels Myocardial Contraction Stenosis Echocardiography Cardiology Arterial blood Female business Cardiology and Cardiovascular Medicine |
| Zdroj: | Journal of the American College of Cardiology. 22(1):127-134 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/0735-1097(93)90826-m |
| Popis: | Objectives. This study was designed to determine the efficacy of synchronized coronary sinus retroperfusion of arterial blood in reducing myocardial ischemia associated with the performance of high risk coronary angioplasty.Background. Previous animal and clinical work has demonstrated the efficacy of this technique in supporting ischemic myocardium.Methods. Twenty-one patients were randomized to alternately receive coronary sinus retroperfusion support during either the second or the third coronary angioplasty balloon inflation, after an initial unsupported brief control inflation. Myocardial ischemia was assessed by the extent of echocardiographic left ventricular wall motion abnormality, quantified ST segment deviation and hemodynamic and anginal variables during balloon inflations performed with and without coronary sinus retroperfusion support. Regional wall motion score was defined as hyperkinesia (−1), normokinesia (0), hypokinesia (+1), akinesia (+2) and dyskinesia (+3).Results. A reduction in the echocardiographic left anterior descending regional wall motion score in retroperfusion-supported (1.7 ± 2.1) versus unsupported (2.7 ± 1.6) inflations (p < 0.05) was noted. Twelve-lead electrocardiographic monitoring revealed no additional ST segment deviation during supported (173 ± 95 s) compared with unsupported (129 ± 87 s) angioplasty inflations despite a significantly longer duration of supported inflations (p < 0.004). Mean and peak systolic coronary sinus pressures differed during supported inflations (21 ± 6 and 44 ± 13 mm Hg) versus unsupported inflations (10 ± 4 and 16 ± 5 mm Hg) (p < 0.001). There was no difference in hemodynamic or anginal variables.Conclusions. A reduction in ischemia as defined by wall motion abnormality during retroperfusion-supported compared with unsupported angioplasty balloon inflations was documented. No additional ST segment deviation occurred during retroperfusion-supported compared with unsupported balloon inflations despite a significantly longer duration of supported inflations. No difference in hemodynamic or anginal variables was noted. |
| Databáze: | OpenAIRE |
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