Direct myocardial revascularization and therapeutic angiogenesis
| Autor: | A. Tandar, Gordon M. Saperia, David H. Spodick |
|---|---|
| Rok vydání: | 2002 |
| Předmět: |
Clinical Trials as Topic
medicine.medical_specialty Contraction (grammar) Myocardial revascularization Neovascularization Pathologic business.industry medicine.medical_treatment Coronary Disease Revascularization Transmyocardial revascularization Surgery Neovascularization Myocardial Revascularization cardiovascular system medicine Humans Therapeutic angiogenesis medicine.symptom Cardiology and Cardiovascular Medicine business Perfusion Endocardium |
| Zdroj: | European Heart Journal. 23:1492-1502 |
| ISSN: | 0195-668X |
| Popis: | Interest in direct myocardial perfusion began when Pratt, in 1898, observed persistent myocardial contraction for several hours in ex vivo feline ventricles directly perfuse through the semilunar valves. In 1933 Wearn described ‘myocardial sinusoids’ bathing reptilian ventricular myocytes that do not contain any significant blood supply from the coronary vasculature, eluting the possibility of direct myocardial perfusion via channels from the ventricles. Sen later tested this theory by mechanically creating channels, through direct needle puncture (acupuncture) in the myocardium; short-term reduction in the magnitude of myocardial infarcts and decreased mortality in the treatment group were observed. However, many newly created channels closed with scar tissue over time. Interest in direct myocardial revascularization was revived in the 1970s when lasers were shown to create channels with minimal damage to surrounding tissues. Direct myocardial revascularization, either surgical or catheter-based, is the creation of communicating channels between the left ventricular cavity and ischaemic myocardial tissues via transmyocardial revascularization and percutaneous transmyocardial revascularization modalities. In transmyocardial revascularization (Fig. 1), channels are created directly from the epicardium to the endocardium of the chronically ischaemic, yet viable (hibernating) left ventricular myocardium using lasers or via mechanical means (needle puncture) during open chest surgery. Although the method used in channel creation is similar in percutaneous transmyocardial revascularization (Fig. 2), channels are produced from the endocardium to the ischaemic myocardium using |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|