Left Ventricular Hemodynamics, Regional Blood Flow, and Lactate Metabolism During Balloon Occlusion: Can we Alter the Sequence of Ischemic Events?
Shortly after the introduction of percutaneous transluminal coronary angioplasty (PTCA) in 1977 , the indications for the procedure were viewed conservatively: disease limited to a proximal stenotic lesion in a single vessel, stable angina pectoris, and normal ventricular function. This resulted in relatively short episodes of occlusion during the procedure in relatively healthy hearts. Today, after 5 years of experience with PTCA, these indications have been extended to include distal stenotic lesions in up to three vessels requiring multiple dilatations. Patients with unstable angina and impaired ventricular function have been included. Furthermore, PTCA is performed in stenotic bypass grafts and for residual stenosis after fibrinolytic recanalization during acute or impending myocardial infarction. As a result, the total duration of occlusive episodes during PTCA has increased (Fig. 1): the median is now 4 min and a few cases exceed 10 min in our laboratory.
KeywordsLactate Measurement Great Cardiac Vein Coronary Sinus Blood Flow Coronary Sinus Flow Impaired Ventricular Function
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- Griintzig AR, Senning A, Siegenthaler WE (1979) Nonoperative dilatation of coronary artery stenosis. Percutaneous transluminal coronary angioplasty. N Engl J Med 301: 61–68Google Scholar
- Verdouw PD, Stam H, Remme WJ (1980) Fundamental validity and clinical usefulness of myocardial lactate balance during ischemia. A comparison with other biochemical markers. In: Moret PR, Weber J, Haissly JC, Denolin H (eds) Lactate. Physiologic, methodologic and pathologic approach. Springer, Berlin Heidelberg New York, pp 207–223Google Scholar
- Verdouw PD, Ten Cate FJ, Schamhardt HC, Bastiaans OL, Van der Hoek TM (1980) Segmental myocardial function during progressive coronary flow reductions and its modification by pharmacological interventions. In: Kreuzer H, Parmley WW, Rentrop P, Weiss HW (eds) Advances in clinical cardiology, vol 1: Quantification of myocardial ischemia. Witzstrock, New York, pp 270–284Google Scholar
- Nayler WG (1983) Calcium and cell death. Eur Heart J [Suppl C] 4: 33–41Google Scholar
- Fleckenstein A, Fleckenstein–Gruen G (1980) Cardiovascular protection by Ca-antago-nists. Eur Heart J [Suppl B] 1: 15–21Google Scholar
- Serruys PW, Hooghoudt TEH, van den Brand M, Hugenholtz PG (1981) Influence of intracoronary nifedipine on left ventricular performance and myocardial oxygen consumption in human subjects. Eur Heart J [Suppl A] 2: 51Google Scholar