Abstract
Background: The purpose was to develop a novel hypothetical method to increase the size of coronary arteries.Methods: During long-term observation an increase in coronary size has been seen in three unexpected scenarios. Changes in coronary artery sizes were observed in patients with mitral stenosis (n=69) by angiogram prior to percutaneous balloon mitral valvuloplasty or valve replacement surgery for severe mitral stenosis. The coronaries of patients with patent ductus arteriosus who underwent surgical closure in the past (n=14) were examined by echocardiogram. Patients with renal failure on long-term dialysis through peripheral arterio-venous fistula without left ventricular hypertrophy (n=17) were studied by echocardiography. Normal age, weight and sex matched coronary sizes served as controls in the study. All these observations were made over a period of 12 years.Results: The sizes of coronaries in patients with mitral stenosis, patients who underwent closure for patent ductus arteriosus, and in patients on hemodialysis through arteriovenous fistulas were higher than normal controls (p<0.05, for all). A hypothetical model to increase the coronary sizes could be developed based on the analysis of the differential equations of Poiseuille’s. A method is proposed of creating a peripheral arterio-venous fistula, which could be closed later electively by a percutaneous method/surgery. The closure time needs to be determined by experimental studies. The other methods could be a continuous exercise program or by the use of beta-blockers.Conclusion: A novel hypothetical method of peripheral arteriovenous fistula formation is decsribed which could potentially increase the size of the coronaries, which could be closed later.
Highlights
It is a common observation to visualize thin coronaries in long-standing diabetic and hyperlipidemic individuals
Coronary diameters were measured in the left main coronary artery (LMCA), Left anterior descending artery and the right coronary artery within 3mm from the coronary ostium (Philips IE33, HP Sonos 5500 and Sonosite M-Turbo)
The results presented in the study are from 3 subsets of dis-jointed patient subgroups, who are not related to each other, and the study was performed in various timings. They had one aspect in common, which was the varying degrees of dilatation of coronaries, without dilatation or hypertrophy of the left ventricle. This could be due the fall in the mean arterial pressure compared to the controls, and in other two subgroups, it is possibly related to the existing or the closed arterio-ventricular fistulas
Summary
It is a common observation to visualize thin coronaries in long-standing diabetic and hyperlipidemic individuals. It is interesting to identify a method to increase the size of the coronary arteries. This would be challenging and therapeutically useful. An increase in size would result in the lesser incidence of coronary events. In diabetic patients, there is a reduction in arterial sizes due to deposition of advanced glycosylated end products[3]. Hyperlipidemic conditions due to deposition of the micro cholesterol particles lead to a reduction in the coronary dimensions and result in increased coronary events[4]. Reduction in the caliber of the blood vessels leads to a reduced volume of blood flow as well as an increase in wall shear stress[5] and results in earlier coronary events. The purpose was to develop a novel hypothetical method to increase the size of coronary arteries
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