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Regional myocadial blood flow and cardiac mechanics in dog hearts with CO2 laser-induced intramyocardial revascularization

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Summary

Laser-induced intramyocardial revascularization (LIR) has been used to promote direct communications between blood within the ventricular cavity and that of the existing myocardial vasculature in an attempt to increase perfusion in patients with ischemic heart discase. This study was conducted to measure the effects of LIR channels on regional myocardial flood flow (microspheres), cardiac mechanics (sonomicrometers), and myocardial tissue pressures in 18 dogs. Under baseline hemodynamic conditions (mean HR=165.2±11.4 bpm, LVP=123.6±22.9/4.0±1.8 mmHg, AoP=112.8±27.1/77.0±22.5 mmHg), myocardial blood flow in laser-treated tissue (mean =1.11±.10 cc/min/gm before laser; .71±.19 cc/min/gm after laser) was reduced as compared to blood flow in control tissue (mean=1.12±.15 cc/min/gm before laser; 1.25±.22 cc/min/gm after laser). Regional myocardial systolic shortening (11.32%±3.82% before laser; 7.49%±2.86% after laser) was decreased by 33%. During simultaneous reversible ligation of the LAD and LCCA for 2 min, when intramyocardial channels represented the only tissue access for the injected microspheres, blood flow in laser-treated tissue was not increased above that of the control non-lasered tissue. However, regional blood flow was greater in laser-treated ischemic tissue (mean=.61±.12 cc/min/gm) than in untreated ischemic areas (mean=.04±.03 cc/min/gm) when left ventricular pressure (LVP) was acutely elevated (mean SLVP=207.0±16.1 mmHg). Using these measurements, a model is proposed to predict regional systolic pressure gradients between the left ventricular cavity and coronary intramyocardial vasculature required to permit restoration of blood flow to ischemic myocardium. We conclude that improved perfusion via laser-induced intramyocardial channels does not occur in otherwise normal myocardium exposed to acute coronary ligation and only small improvements in perfusion are noted when LVP is significantly elevated. Consideration of further clinical application of this approach is seriously cautioned awaiting additional experimental studies.

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Author notes

  1. R. W. Millard

    Present address: Department of Physiology and Biophysics, University of Cincinnati College of Medicine, 231 Bethesda Avenue, 4567-0575, Cincinnati, Ohio, USA

  2. R. I. Hardy MD, PhD

    Present address: Stanford University Medical Center, 300 Pasteur Drive, 94305, Stanford, California, USA

Authors and Affiliations

  1. Division of Cardiology, Children's Hospital Medical Center, 231 Bethesda Avenue, 4567-0575, Cincinnati, Ohio, USA

    R. I. Hardy MD, PhD, F. W. James, R. W. Millard & S. Kaplan

  2. Department of Physiology and Biophysics, University of Cincinnati College of Medicine, 231 Bethesda Avenue, 4567-0575, Cincinnati, Ohio, USA

    R. I. Hardy MD, PhD, F. W. James & S. Kaplan

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  1. R. I. Hardy MD, PhD
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  2. F. W. James
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  4. S. Kaplan
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Additional information

This study was supported by U.S. Public Health Service Grant R01 HL32897-01 from the National Heart, Lung, and Blood Institute, by grants in aid from the American Heart Association, and by the Fulbright-Hays Scholarship Grant.

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Hardy, R.I., James, F.W., Millard, R.W. et al. Regional myocadial blood flow and cardiac mechanics in dog hearts with CO2 laser-induced intramyocardial revascularization. Basic Res Cardiol 85, 179–197 (1990). https://doi.org/10.1007/BF01906971

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  • DOI: https://doi.org/10.1007/BF01906971

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