Skip to main content
SpringerLink
Log in

Functional significance of coronary collaterals in man

Die funktionelle Bedeutung des Kollateralkreislaufes beim Menschen

  • Original Contributions
  • Published:
Basic Research in Cardiology Aims and scope Submit manuscript

Summary

In 29 patients with coronary artery disease the functional significance of coronary collaterals was studied during surgery for aortocoronary bypass grafting.

Poststenotic coronary pressure and postocclusion graft flow hyperemia were measured in 34 vessels receiving a coronary bypass graft. The vessels were divided into groups according to the angiographically determined degree of coronary stenosis: group I: stenosis up to 80%, group II: stenosis between 80 and 90%, group III: stenosis between 90 and 100%, Group IV: acute occlusion without visible collaterals and Group V: complete occlusions with collaterals. When a coronary stenosis surpasses 80% luminal narrowing it becomes hemodynamically significant: pressure gradient over the stenosis becomes significant and there appears a hyperemic response after graft occlusion. From group I to IV poststenotic coronary pressure decreases and graft flow hyperemia increases significantly (p<0.05).

In all cases general coronary vasodilation was produced by intracoronary injection of dipyridamole. After vasodilation poststenotic coronary pressure decreased significantly (p<0.05) in groups I and II but not in III and IV. This indicates that there is still some increase in flow over the stenosis i.e. coronary reserve is not completely expended until 90% stenosis. Hyperemic graft flow response correlates well with poststenotic coronary pressure: the relation can be described by an asymptotic regression. This suggests that graft flow hyperemia is a reflection of compensatory peripheral vasodilation rather than a response to ischemia.

In group V, i.e. complete chronic occlusions with collaterals, peripheral coronary pressure was 40.7±3.3% of systemic pressure and this value decreased significantly (p=0.002) to 34.0±2.6% after vasodilation. Hyperemic response was 1.57±0.07. These values are significantly different from groups I and IV, but not from II and III.

These findings suggest that coronary collaterals restore coronary reserve partially. Nevertheless, a chronic coronary occlusion compensated by collaterals corresponds functionally to a 90% pure stenosis.

Zusammenfassung

Die Bedeutung des koronaren Kreislaufes wurde an 29 Patienten mit koronarer Herzerkrankung während der aortokoronaren Bypassoperation untersucht. Poststenotischer Koronararteriendruck und Graftfluß vor und 30 sec nach Graftverschluß wurden an 34 Gefäßen, die mit einem aortokoronaren Bypass versorgt wurden, gemessen. Nach dem angiografisch bestimmten Grad der Koronararterienstenose (% Lumeneinengung) wurden folgende Gruppen gebildet: Gruppe I = Stenose bis 80%, Gruppe II = Stenose zwischen 80 und 90%. Gruppe III = Stenose zwischen 90 und 100%, Gruppe IV = akuter Verschluß ohne angiographisch sichtbare Kollateralen und Gruppe V = kompletter Verschluß mit Kollateralen. Wenn eine Koronarstenose 80% Lumeneinengung erreicht, wird sie hämodynamisch bedeutsam, es entsteht ein signifikanter Druckgradient über die Stenose und eine signifikante Hyperämie nach Öffnen des Grafts. Von Gruppe I bis IV fand sich ein signifikanter Abfall des poststenotischen Druckes und ein signifikanter Anstieg des hyperämischen Graftflusses. Maximale koronare Vasodilatation wurde durch Injektion von Dipyridamol in den Graft induziert. Der poststenotische Druck fiel nach Vasodilatation signifikant ab in Gruppe I und II, nicht in III und IV. Dies bedeutet, daß unter 90% Stenose immer noch der Fluß über die Stenose gesteigert werden kann, die Koronar-reserve ist nicht völlig aufgebraucht. Eine signifikante asymptotische Relation besteht zwischen hyperämischem Graftfluß und poststenotischem Druck. Dies weist darauf hin, daß die hyperämische Reaktion nach Graftverschluß ein Maß der poststenotischen Vasodilatation ist und nicht ein Zeichen von Ischämie. In Gruppe V (kompletter Verschluß mit Kollateralen) war der poststenotische Druck 40,7±3,3% des systemischen Druckes, und dieser Wert fiel signifikant auf 34,0±2,6% nach Vasodilation ab. Die Hyperämie nach Öffnen des Grafts betrug 1,57±0,07 des Kontrollflusses. Diese Werte sind signifikant unterschiedlich von Gruppe I und IV, nicht von II und III.

Wir schließen daraus, daß koronare Kollateralen die Koronarreserve teilweise wiederherstellen. Ein chronischer Koronarverschluß mit Kollateralen entspricht funktionell einer 90%igen Koronarstenose ohne Kollateralen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Gregg, D. E., J. J. Thornton, F. R. Mautz: Magnitude, adequacy and source of collateral blood flow and pressure in chronically occluded coronary arteries. Amer. J. Physiol.127, 161–175 (1933).

    Google Scholar 

  2. Kattus, A. A., D. E. Gregg: Some determinants of coronary collateral flow in the open chest dog. Circulat. Res.7, 628–642 (1959).

    PubMed  Google Scholar 

  3. Schaper, W.: Collateral circulation of the heart (Amsterdam 1971).

  4. Flameng, W., W. Schaper, P. Lewi: Multiple experimental coronary occlusion without infarction. Amer. Heart J.85, 767–776 (1973).

    Article  PubMed  Google Scholar 

  5. Harris, C. N., M. A. Kaplan, D. P. Kaplan et al.: Anatomic and functional correlates of intercoronary collateral vessels. Amer. J. Cardiol.30, 611–614 (1972).

    Article  PubMed  Google Scholar 

  6. Bjork, L.: Angiographic demonstration of collaterals to the coronary arteries in patients with angina pectoris. Acta Radiol. Diagn. (Stockholm)8, 305–309 (1969).

    Google Scholar 

  7. Lavine, P., Z. Filip, M. Naymi et al.: Clinical and hemodynamic evaluation of coronary collateral vessels in coronary artery disease. Amer. Heart J.87, 343–349 (1974).

    Article  PubMed  Google Scholar 

  8. Hellant, R. H., S. Voronas, G. Gorlin: Functional importance of the human coronary collateral circulation. New Engl. J. Med.284, 1277–1281 (1971).

    PubMed  Google Scholar 

  9. Caroll, R. J., M. S. Verani, H. L. Falsetti: The effect of collateral circulation on segmental left ventricular contraction. Circulation50, 709–713 (1974).

    PubMed  Google Scholar 

  10. Vismara, L. A., R. R. Miller, A. N. de Maria et al: Collateral circulation in chronic coronary disease. Effects on segmental left ventricular contractile function. (Abstr.) Amer. J. Cardiol.35, 174 (1975).

    Article  Google Scholar 

  11. Shah, R., M. Bodenheimer, V. S. Bander et al.: The relationship between severity and extent of asynergy and the coronary collateral circulation. (Abstr.) Clin. Res.23, 208 A (1975).

    Google Scholar 

  12. Martinez-Rois, M. A., B. C. B. da Costa, Cecena-Seldne et al.: Normal electrocardiogram in the presence of severe coronary artery disease. Amer. J. Cardiol.25, 320–324 (1970).

    PubMed  Google Scholar 

  13. Levin, D. C.: Pathways and functional significance of the coronary collateral circulation. Circulation50, 831–837 (1974).

    PubMed  Google Scholar 

  14. Hecht, H. S., J. M. Areosty, P. J. la Raia et al.: Role of the coronary collateral circulation in the preservation of left ventricular function. (Abstr.) Circulation48, Suppl. IV-87 (1973).

    Google Scholar 

  15. Levin, D. C., H. A. Baltaxe: Role of coronary collateral circulation and distal run-off in preserving myocardial contractility. (Abstr.) Circulation48, Suppl. IV, IV-88 (1973).

    Google Scholar 

  16. Hamby, R. I., A. Aintablian, A. Schwartz: Reappraisal of the functional significance of toe coronary collateral circulation. Amer. J. Cardiol.38, 305–309 (1976).

    Article  Google Scholar 

  17. Blumgart, H. L., M. J. Schlesinger, D. Davis: Studies on the relation of the clinical manifestation of angina pectoris, coronary thrombosis and myoardial infarction to the pathologic findings: with particular reference to the significance of the collateral circulation. Amer. Heart J.19, 1–91 (1940).

    Article  Google Scholar 

  18. Schaper, W., W. Flameng, B. Winkler et al.: Quantification of collateral resistance in acute and chronic experimental coronary occlusion in the dog. Circulat. Res.39, 371–377 (1976).

    PubMed  Google Scholar 

  19. Brown, B. G., E. Bolson, M. Frimer et al.: Quantitative coronary arteriography. Circulation55, 329–337 (1977).

    PubMed  Google Scholar 

  20. Gregg, D. E.: The natural history of coronary collateral development. Circulat. Res.35, 335–344 (1974).

    PubMed  Google Scholar 

  21. Goldstein, R. E., E. B. Stinson, J. L. Scherer: Intraoperative coronary collateral function in patients with coronary artery disease. Circulation49, 298–308 (1974).

    PubMed  Google Scholar 

  22. Goldstein, R. E., L. L. Michaelis, A. G. Morrow, S. E. Epstein: Coronary collateral function in patients without occlusive coronary artery disease. Circulation51, 118–125 (1975).

    PubMed  Google Scholar 

  23. Parker, F. B., J. F. Neville, E. L. Hanson, W. R. Webb: Retrograde and antegrade pressure and flows in preinfarction syndrome. Circulation, Suppl. II,49 and50, 122–126 (1974).

    Google Scholar 

  24. Webb, W. R., F. B. Parker: Retrograde pressures and flows in coronary arterial disease. Ann. Thor. Surg.15, 256–262 (1973).

    Google Scholar 

  25. Miller, R. R., D. T. Mason, A. Salel et al.: Determinants and functional significance of the coronary collerateral circulation in patients with coronary artery disease. (Abstr.) Circulation44, Suppl. II, 2–202 (1971).

    Google Scholar 

  26. Thonkon, M., R. R. Miller, A. N. DeMaria et al.: Multifactor analysis in coronary disease. Role of distal flow and severity and number of stenosis. (Abstr.) Amer. J Cardiol.35, 173 (1975).

    Article  Google Scholar 

  27. Demany, M. A., A. Tambe, H. A. Zimmermann: Correlation between coronary arteriogram and the post-exercise electrocardiogram. Amer. J. Cardiol.19, 526–530 (1967).

    Article  PubMed  Google Scholar 

  28. Most, A. S., H. G. Kemp, R. Gorlin: Post-exercise electrocardiography in patient with angiographically documented coronary artery disease. Ann. Intern. Med.71, 1043–1049 (1969).

    PubMed  Google Scholar 

Download references

Author information

Author notes

  1. F. Hehrlein M.D.

    Present address: Dept. Cardiovasc. Surgery, J. L. University Giessen, Klinikstraße 29, Giessen, W. Germany

Authors and Affiliations

  1. Dept. Cardiovasc. Surgery, J. L. University Giessen, Klinikstraße 29, Giessen, W. Germany

    W. Flameng M.D., F. Schwarz M.D. & A. Boel

  2. Med. Data Proc. Div. K. University Leuven, (Belgium)

    W. Flameng M.D., F. Schwarz M.D.,  F. Hehrlein M.D. & A. Boel

Authors
  1. W. Flameng M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Schwarz M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Hehrlein M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Boel
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

With 4 figures and 2 tables

Rights and permissions

Reprints and permissions

About this article

Cite this article

Flameng, W., Schwarz, F., Hehrlein, F. et al. Functional significance of coronary collaterals in man. Basic Res Cardiol 73, 188–199 (1978). https://doi.org/10.1007/BF01906753

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01906753

Keywords

Search

Navigation