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J Appl Physiol 104: 1266-1272, 2008. First published February 21, 2008; doi:10.1152/japplphysiol.00063.2008
8750-7587/08 $8.00
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INVITED REVIEWS

Coronary venous retroperfusion: an old concept, a new approach

Ghassan S. Kassab,1,4 Jose A. Navia,2 Keith March,3,4 and Jenny Susana Choy1

1Departments of Biomedical Engineering, Surgery, and Cellular and Integrative Physiology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana; 2Department of Cardiac Surgery, Austral University, Buenos Aires, Pilar, Argentina; and 3Department of Medicine and 4Indiana Center for Vascular Biology and Medicine, Indiana University School of Medicine, Indianapolis, Indiana

Submitted 21 January 2008 ; accepted in final form 12 February 2008

The potential of the coronary veins for revascularization has been evaluated by many investigators for more than a century. The major hurdle has been the damage of veins during sudden exposure to arterial pressure. The solution to this problem has typically involved the use of intricate and complicated apparatus and devices, which has prevented routine clinical utility in the catheterization laboratory. This review examines this old concept from a new perspective and proposes a novel hypothesis to address previous shortcomings. We speculate on an approach that may serve to eliminate the edema and hemorrhage that result during venous retroperfusion as the pressure is suddenly increased to arterial values. We propose the rationale to increase the venous pressure to arterial values more gradually to allow prearterializations of the veins before full exposure of arterial pressure. Finally, we discuss various possible indications for this selective autoretroperfusion strategy to combat myocardial ischemia in cardiogenic shock patients, ST-elevation myocardial infarct patients, no-option patients, and beyond.

coronary veins; remodeling; myocardial ischemia


Address for reprint requests and other correspondence: G. S. Kassab, Dept. of Biomedical Engineering, IUPUI, 723 W. Michigan St., Indianapolis, IN 46202 (e-mail: gkassab{at}iupui.edu)






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