Coronary Sinus Interventions Research Articles

SYNCHRONIZED RETROPERFUSION COMBINED WITH CORONARY SINUS OCCLUSION: EXPERIMENTAL MEASUREMENTS COMPARED WITH SIMULATION RESULTS AND MODEL PREDICTIONS

A mathematical model has been developed to investigate the hemodynamic effects of different modes of coronary sinus interventions. To compare the predictions of this model with experimentally derived results, six open chested dogs with coronary artery occlusions were studied. Aortic pressure, coronary venous pressure, and LAD pressure distal to the occlusion were measured. Throughout each experiment, retroperfusion of arterial blood into the coronary sinus, synchronized to diastole (SRP), was performed at flow rates of 25, 50, 75, and 100 ml/min. In each dog, two modes of superimposed coronary sinus occlusion were investigated: mode 1, the coronary sinus was occluded only during diastole; mode 2, coronary sinus occlusion was extended until coronary sinus pressure reached a plateau. The validity of the model was confirmed by a satisfactory agreement between the experimentally and mathematically derived

The momentum of coronary sinus interventions clinically.

The momentum of coronary sinus interventions clinically.

Coronary sinus interventions: from concept to clinics.

For almost 100 years the coronary venous system has attracted researchers as an access route to deprived myocardium. Different concepts have been tried and numerous experimental studies have been performed to evaluate whether coronary sinus occlusion, retroinfusion, and retroperfusion of arterial blood via the coronary sinus represent an effective treatment of myocardial ischemia. The early successful studies of Drs. Gregg, Eckstein, Beck and others led to the application of the Beck II procedure, a permanent retroperfusion technique used in the early 1950s to revascularize patients with diffuse atherosclerosis. The coronary sinus route was also used to retroperfuse blood intraoperatively during opening of the heart to keep the heart beating. Excessive mortality and severe side effects, such as myocardial edema and hemorrhage, and an insufficiently advanced technology resulted in the temporary demise of the coronary sinus approaches. Recently, however, the need to improve myocardial protection, despite enormous advances in coronary bypass surgery and interventional cardiology, has resulted in renewed interest in the coronary sinus as an access route to deprived myocardium. Advances in technology such as percutaneous catheter techniques have improved access to the coronary venous system and allowed for a physiological adaptation of coronary sinus retroperfusion techniques. Today the three major coronary sinus techniques, i.e., sychronized retroperfusion (SRP), retroinfusion of cardioplegia during cardiac arrest and retroinfusion of pharmaceutical agents in the normal working heart, and pressure-controlled intermittent coronary sinus occlusion (PICSO) have been documented as providing superior protection of jeopardized myocardium in selected subsets of patients. All of these techniques currently are under clinical consideration; the retroinfusion of cardioplegia has already found wide clinical acceptance, SRP and PICSO have only recently been tested in first clinical trials. Due to a vast resurgence in interest, it is desirable to survey the results obtained with each of these techniques, to discuss the pathophysiology and mode of action of coronary sinus interventions, and to assign them a place in the perspective of conventional therapies. Furthermore, an attempt will be made to weigh individual coronary sinus techniques against each other, discuss in which clinical settings each of them may be most effective, and define issues facing current development.