Anatomical basis and short-term effect of in situ coronary venous arterialization

Abstract

To study the anatomical basis of in situ coronary venous arterialization (ICVA) and to observe the short-term clinical outcome thereof. Five recently isolated pig hearts underwent ligation of the posterior descending artery and the proximal end of middle cardiac vein (MCV), solution of Indian ink was perfused into this vein, and slices of heart were made to observe the distribution of ink through microscope. From January 2002 to December 2005, 64 consecutive patients with diffuse lesion and distal occlusion of right coronary artery received coronary artery bypass grafting (CABG) were randomly divided into 2 equal groups to undergo ICVA during CABG (ICVA group) and conventional CABG only (control group) respectively. The pre- and post-operation clinical data, including ECG, SPECT and ultrasonic cardiograph (UCG) were analyzed. Indian ink was distributed in the intercellular spaces and capillaries of the myocardium and appeared in the micro-arteries in all 5 pig hearts. The mean hospitalization time of the ICVA patients was 16.5 +/- 7.7 days. The mortality rate was 0. After the ICVA the ECG recovery rate in ST segment was 98.88%, and the improvement rate in the grade of the angina was 100%. SPECT and UCG both showed great improvement post-operatively (P < 0.05). After the ligation of the proximal end of MCV, the related myocardium can be perfused effectively by distal arterialization in situ. ICVA, fitting to patients with diffused lesion and distal occlusion of coronary artery, can be performed safely with satisfactory clinical outcomes.