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Invited Review: Ghassan S. Kassab, Jose A. Navia, Keith March, and Jenny S. Choy Coronary Venous Retroperfusion: An Old Concept, a New Approach J Appl Physiol 2008; 0: 00063.2008v1 [Abstract] [PDF]

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The clinical potential of coronary sinus interventions

Werner Mohl, Guenter Weigel, Stefan Mina and Hirofumi Kasahara   (16 July 2008)

The clinical potential of coronary sinus interventions 16 July 2008
Werner Mohl, MD,PhD Medical University of Vienna, Guenter Weigel, Stefan Mina and Hirofumi Kasahara Send letter to journal: Re: The clinical potential of coronary sinus interventions werner.mohl{at}meduniwien.ac.at Werner Mohl, et al.	We read with interest the review on retroperfusion concepts recently published by Kassab and colleagues (4). Although this article gives a good overview on the topic some parts are missing or misinterpreted. Especially the notion that autoperfusion is a new concept is much to our surprise. Instead we believe that the current concept of autoperfusion is a sophisticated interventional reproduction of the Beck´s II procedure. As known this operation involved a narrowing of the coronary sinus and subsequent closure with shunting of arterial blood through a saphenous graft from the descending aorta to the coronary veins. This implements that pressure as well as arterialisation of blood has effects on the coronary venous system. In a meta-analysis Syeda (1) reported on the effects of different coronary sinus interventions on infarct size reduction. In her paper she was able to show a negative relationship between the amount of retroperfused blood and salvage and a positive relationship with developed coronary sinus pressure discriminating the concepts of retroperfusion of arterial blood and coronary sinus pressure elevation. Weigel (2) and colleagues reported recently on another very important consequence of coronary sinus techniques namely the activation of endothelium and subsequent molecular cascades obviously leading to regeneration. Therefore we feel that this overview on retroperfusion techniques only reporting on coronary venous arterialisation leaves out an important part of the pathophysiology of coronary sinus interventions. Furthermore the proposed autoperfusion techniques have to be balanced and justified against less invasive concepts like PICSO in translational research, since recently published data on this technology show interesting results on infarcts size reduction and clinical significance (3). Overall we are in complete agreement with the authors that coronary sinus techniques have an unexplored clinical potential which has to be analysed with outmost scientific scrutiny and state of the art technology. References 1. Syeda B, Schukro C, Heinze G, et al. The salvage potential of coronary sinus interventions: meta-analysis and pathophysiologic consequences. J Thorac Cardiovasc Surg 2004;127(6):1703-12. 2. Weigel G, Kajgana I, Bergmeister H, et al. Beck and back: a paradigm change in coronary sinus interventions--pulsatile stretch on intact coronary venous endothelium. J Thorac Cardiovasc Surg 2007;133(6):1581-7. 3. Mohl W, Komamura K, Kasahara H, et al. Myocardial protection via the coronary sinus. Circ J 2008;72(4):526-33. 4. Kassab GS, Navia JA, March K, and Choy JS. Coronary venous retroperfusion: an old concept, a new approach. J Appl Physiol, May 2008; 104: 1266 - 1272.