The Effect of Pressure-Controlled Intermittent Coronary Sinus Occlusion on the Reduction of the Myocardial Infarction Size

Choe, Seong Choon; Han, Ki Hoon; Park, Dae Gyun; Chung, Woo Yong; Kim, Hyo Soo; Sohn, Dae Won; Kim, Cheol Ho; Oh, Byung Hee; Lee, Myoung Mook; Park, Young Bae; Choi, Yun Shik; Seo, Jung Don; Lee, Young Woo

Abstract

BACKGROUND
Pressure-controlled intermittent coronary sinus occlusion(PICSO) as well as synchronized retrograde perfusion(SRP) have emerged as a new technique that can redirect blood through the coronary sinus to nourish ischemic myocardium beyond a coronary occlusion. Also, coronary sinus occlusion pressure(CSOP) can be measured during application of PICSO. This experimental study was to determine the characteristics of CSOP and the effects of PICSO on the reduction of infarct size in experimentally induced acute myocardial infarction. METHOD: 22 dogs were included in this study, 9 in control group and 13 in PICSO group. Thirty minutes after experimental ligation of proximal left anterior descending artery, PICSO device was applied to PICSO group for 4 hours. Systolic and end-diastolic pressure of CSOP, LVEDP(left ventricular end-diastolic pressure), LVSP and aortic pressure with heart rate were measured every 1 hour. After 4 hours, heart was excised and 1% TTC(triphenyl tetrazolium cholride) solution was perfused distal to left anterior descending(LAD) coronary artery to measure the area of viable myocardium in LAD territory. 'The area at risk(LAD territory/LV surface area)' and 'the area of necrosis(necrosis area/LAD territory)' were calculated with cut surface of LV using planimetry.
RESULTS
1) End-diastolic pressure of CSOP and left ventricular end-diastolic pressure(LVEDP) were closely equalized and significantly correlated each other(p<0.001). 2) Aortic pressure profiles, left ventricular pressure profiles and heart rate during coronary occlusion did not differ significantly from the control group. Aortic and left ventricular systolic and mean pressures declined significantly after 1 hour of coronary occlusion. Also LVEDP increased significantly after 1 hour of coronary occlusion(p<0.01). 3) The area of myocardium at risk was similar in both groups(control 12.0+/-2.1 %, PICSO 11.5+/-1.2%). But the results of the area of necrosis within the area of risk showed that PICSO significantly reduces myocardial infarct size(control 79.1+/-4%, PICSO 25.3+/-5%).
CONCLUSION
PICSO can be indicated in acute coronary syndrome to reduce the myocardial necrosis especially in LAD territory. In addition, PICSO can be used to evaluated LVEDP by measuring CSOP,especially in patients with severe aortic valvular stenosis. Further study is needed upon the effectiveness of PICSO on clinical situations and precise metabolic effects of PICSO on myocardium.