Coronary Artery Reperfusion: Early Effects on Coronary Hemodynamics

  • Colin M. Bloor
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 39)


Since cardiac failure in acute myocardial infarction most likely results from a large myocardial infarct (1, 2), several experimental approaches to effectively decrease the size of the developing infarct (3–9) have been made. In general, these approaches either decrease myocardial oxygen demand relative to supply or enhance anaerobic metabolism. A more direct approach would increase oxygen supply by restoring blood flow beyond the site of obstruction, i.e., coronary artery reperfusion. When coronary reperfusion was established within 3 hours of occlusion, significant myocardial tissue was salvaged and impaired left ventricular function was reversed (10, 11). These studies assume that since the coronary vascular bed is usually anatomically patent beyond the site of obstruction (12, 13) the coronary vascular bed has maintained the same capability to carry flow at all times. But evidence from other vascular beds shows that when occlusion is of sufficient duration, functional changes may occur which can impair the ability of the vascular bed to maintain flow when reperfusion is instituted (14). Accordingly, we sought to determine whether the duration of ischemia can alter the functional capacity of the coronary vascular bed at the time of reperfusion.


Coronary Blood Flow Coronary Occlusion Reactive Hyperemia Flow Response Myocardial Infarct Size 
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  1. 1.
    Harnarayan, C., Bennett, M.A., Pentecost, B.L., and Brewer, D. B.: Quantitative study of infarcted myocardium in cardiogenic shock. Brit. Heart J. 32:728–732, 1970.PubMedCrossRefGoogle Scholar
  2. 2.
    Page, D.L., Caulfield, J.B., Kastor, J.A., De Sanctis, R.W., and Sanders, C.A.: Myocardial changes associated with cardiogenic shock. New Eng. J. Med. 285:133–137, 1971.PubMedCrossRefGoogle Scholar
  3. 3.
    Maroko, P.R., Kjekshus, J.K., Sobel, B.E., Watanabe, T., Covell, J.W., Ross, J., Jr., and Braunwald, E.: Factors influencing infarct size following experimental coronary artery occlusion. Circulation 43:67–82, 1971.PubMedCrossRefGoogle Scholar
  4. 4.
    Maroko, P.R., Libby, P., Sobel, B.E., Bloor, C.M., Sybers, H.D., Shell, W.E., Covell, J.W., and Braunwald, E.: The effect of glucose-insulin-potassium infusion on myocardial infarction following experimental coronary artery occlusion. Circulation 45:1160–1175, 1972.PubMedCrossRefGoogle Scholar
  5. 5.
    Maroko, P.R., Bernstein, E.F., Libby, P., De Laria, G.A., Covell, J.W., Ross, J., Jr., and Braunwald, E.: The effects of intra-aortic balloon counterpulsation on the severity of myocardial ishcemic injury following acute coronary occlusion. Circulation 45:1150–1159, 1972.PubMedCrossRefGoogle Scholar
  6. 6.
    Maroko, P.R., Libby, P., Covell, J.W., Sobel, B.E., Ross, J., Jr., and Braunwald, E.: Precordial S-T segment elevation mapping: An atraumatic method for assessing alterations in the extent of myocardial ischemic injury. The effects of pharmacologic and hemodynamic interventions. Am. J. Cardiol. 29:223–230, 1972.PubMedCrossRefGoogle Scholar
  7. 7.
    Libby, P., Maroko, P.R., Covell, J.W., Malloch, C.I., Ross, J., Jr., and Braunwald, E.: The effects of practolol on left ventricular function and infarct size following acute experimental coronary occlusion. Clin. Res. 19:116, 1971 (Abstract).Google Scholar
  8. 8.
    Libby, P., Maroko, P.R., Shell, W.E., Bloor, C.M., Sobel, B.E., and Braunwald, E.: Decrease in the size of acute experimental myocardial infarct by hyaluronidase administration. Circulation, 46:430–437, 1972.PubMedCrossRefGoogle Scholar
  9. 9.
    Braunwald, E., Covell, J.W., Maroko, P.R., and Ross, J., Jr.; Effects of drugs and counter-pulsation on myocardial oxygen consumption. Observations on the ischemic heart. Circulation 39(Suppl. 4):220–228, 1969.Google Scholar
  10. 10.
    Maroko, P.R., Libby, P., Ginks, W.R., Bloor, C.M., Shell, W.E., Sobel, B.E. and Ross, J., Jr.: Coronary artery reperfusion. I. Early effects on local myocardial function and the extent of myocardial necrosis. J. Clin. Invest. 51:2710–2716, 1972.PubMedCrossRefGoogle Scholar
  11. 11.
    Ginks, W.R., Sybers, H.D., Maroko, P.R., Covell, J.W., Sobel, B.E., and Ross, J., Jr.: Coronary artery reperfusion. II. Reduction of myocardial infarct size at one week after the coronary occlusion. J. Clin. Invest. 51:2717–2723, 1972.PubMedCrossRefGoogle Scholar
  12. 12.
    Alonso, D.R., Carlson, R.G., Roters, F.A., Killip, T., and Lillehei, C.W.: The patency and luminal diameter of distal coronary arteries in fetal, acute myocardial infarction. Arch. Surg. 104:826–830, 1972.PubMedCrossRefGoogle Scholar
  13. 13.
    Berger, R.L. and Stary, H.C.: Anatomic assessment of opera-bility by the saphenousvein bypass operation in coronary-artery disease. New Eng. J. Med. 285:248–252, 1971.PubMedCrossRefGoogle Scholar
  14. 14.
    Sankerin, N.G.: Vascular lesions of malignant hypertension. J. Path. Bact. 103:177–184, 1971.CrossRefGoogle Scholar
  15. 15.
    Gregg, D.E., Khouri, E.M. and Rayford, C.R.: Systemic and coronary energetics in the resting unanesthetized dog. Circ. Res. 16:103–113, 1965.CrossRefGoogle Scholar
  16. 16.
    Bloor, C.M., White, F.C., and Sobel, B.E.: Coronary and systemic hemodynamic effects of prostaglandins in the unanesthetized dog. Cardiovasc. Res. 7:156–166, 1973.PubMedCrossRefGoogle Scholar
  17. 17.
    Sham, G.B., White, F.C., and Bloor, C.M.: A constrictive and occlusive cuff for medium and large blood vessels. J. Appl. Physiol. 28:510–512, 1970.PubMedGoogle Scholar
  18. 18.
    Khouri, E.M., Gregg, D.E., and Lowensohn, H.S.: Flow in the major branches of the left coronary artery during experimental coronary insufficiency in the unanesthetized dog. Circ. Res. 23:99–110, 1968.PubMedCrossRefGoogle Scholar
  19. 19.
    Lavelle, J.F., Bloor, C.M., and Covell, J.W.: A technique for processing coronary hemodynamic data with a small hybrid computing system. Computers in Biol. & Med., 3:47–54, 1973.CrossRefGoogle Scholar
  20. 20.
    Snedecor, G.W.: Statistical Methods. Iowa State University Press, Ames, Iowa, 1956.Google Scholar
  21. 21.
    Sheldon, W.C., Favalaro, R.G., Sortes, F.M., Jr., and Effler, D.B.: Reconstrictive coronary artery surgery, J. Am. Med. Assoc. 213:78–82, 1970.CrossRefGoogle Scholar
  22. 22.
    Greene, D.G., Klocke, F.J., Schimert, G.L., Bunnell, I.L., Wittenberg, S.M. and Lajos, T.: Evaluation of venous bypass grafts from aorta to coronary artery by inert gas desaturation. J. Clin. Invest. 51:191–196, 1972.PubMedCrossRefGoogle Scholar
  23. 23.
    Johnson, W.D., Flemma, R.J., and Lepley, D., Jr.: Determinants of blood flow in aortic-coronary saphenous vein bypass grafts. Arch. Surg. 101:806–810, 1970.PubMedCrossRefGoogle Scholar
  24. 24.
    Cox, J.L., McLaughlin, V.W., Flowers, N.C., and Horan, L.G.: The ischemic zone surrounding acute myocardial infarction. Its morphology as detected by dehydrogenase staining. Am. Heart J. 76:650–659, 1968.PubMedCrossRefGoogle Scholar

Copyright information

© Plenum Press, New York 1973

Authors and Affiliations

  • Colin M. Bloor
    • 1
  1. 1.Department of Pathology, San Diego School of MedicineUniversity of CaliforniaLa JollaUSA

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