Hemodynamic Factors Influencing Regional Ischemia and Infarction of the Myocardium: Difference Between Right and Left Ventricular Myocardial Infarction

  • Hitonobu Tomoike
  • Motoomi Nakamura


The limitations of myocardial infarct size have been studied both experimentally and clinically [1, 2]. Infarct size depends on the size of the area at risk or the extent of perfusion in the occluded vessel [3, 4]. The infarcted area inside the risk area is modified by collateral blood flow [5, 6], timing of reperfusion [7], and hemodynamic factors which determine the level of myocardial oxygen consumption [8, 9]. Myocardial perfusion through the preexisting collateral channels is often inadequate to the extent that myocardial necrosis is virtually a foregone conclusion [2]. Thus, myocardial necrosis begins approximately 20 min after coronary occlusion and spreads as a “wavefront” from the endocardium to epicardium with increasing duration of ischemia [10]. These concepts were derived from studies on the occlusion of a branch of the left coronary artery in a canine model. The potential applicability of these concepts in the right ventricle was not received full approval.


Left Ventricle Infarct Size Myocardial Blood Flow Risk Area Myocardial Necrosis 
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  1. 1.
    Kloner RA, Braunwald E (1980) Observations on experimental myocardial ischemia. Cardiovasc Res 14: 371–395PubMedCrossRefGoogle Scholar
  2. 2.
    Becker LC, Ambrosio G (1987) Myocardial consequences of reperfusion. Prog Cardiovasc Disease 30: 23–44CrossRefGoogle Scholar
  3. 3.
    Schaper W, Remijsen P, Zhonneux R (1969) The size of myocardial infarction after experimental coronary artery ligation. Z Kreislaufforsch 58: 904–909PubMedGoogle Scholar
  4. 4.
    Sakai K, Tomoike H, Ootsubo H, Kikuchi Y, Nakamura M (1982) Preocclusive perfusion area as a determinant of infarct size in a canine model. Cardiovasc Res 16: 408-416PubMedCrossRefGoogle Scholar
  5. 5.
    Geary GG, Smith GT, McNamara JJ (1981) Defining the anatomic perfusion bed of an occluded coronary artery and the region at risk to infarction. A comparative study in the baboon, pig and dog. Am J Cardiol 47: 1240–1247PubMedCrossRefGoogle Scholar
  6. 6.
    Maruoka Y, Tomoike H, Kawachi Y, Noguchi K, Nakamura M (1986) Relations between collateral flow and tissue salvage in the risk area after acute coronary occlusion in dogs; a topological analysis. Br J Exp Pathol 67: 33–42PubMedGoogle Scholar
  7. 7.
    Koren G, Weiss AT, Hasin Y, Appelbaum D, Welber S, Rozenman Y, Lotan C, Mosseri M, Sapoznikov D, Luria MH, Gotsman MS (1985) Prevention of myocardial damage in acute myocardial ischemia by early treatment with intravenous streptokinase. N Engl J Med 313: 1384–1389PubMedCrossRefGoogle Scholar
  8. 8.
    Shell WE, Sobel BE. (1973) Deleterious effects of increased heart rate on infarct size in the conscious dog. Am J Cardiol 31: 474–479PubMedCrossRefGoogle Scholar
  9. 9.
    Nienaber CH, Gottwick M, Winkler B, Schaper W (1983) The relationship between the perfusion deficit, infarct size and time after experimental coronary artery occlusion. Basic Res Cardiol 78: 210–226PubMedCrossRefGoogle Scholar
  10. 10.
    Reimer KA, Lowe IE, Rasmussen MM, Jennings RB (1977) The wavefront phenomenon of ischemic cell death: I. Myocardial infarct size vs. duration of coronary occlusion in dogs. Circulation 56: 786–794PubMedGoogle Scholar
  11. 11.
    Ohzono K, Koyanagi S, Urabe Y, Harasawa Y, Tomoike H, Nakamura M (1986) Transmural distribution of myocardial infarction: Difference between the right and left ventricles in a canine model. Circ Res 59: 63–73PubMedGoogle Scholar
  12. 12.
    Fixler DE, Archie IP, Ullyot DJ, Buckberg GD, Hoffman HE (1973) Effects of acute right ventricular systolic hypertension on regional myocardial blood flow in anesthetized dogs. Am Heart J 85: 491–500PubMedCrossRefGoogle Scholar
  13. 13.
    Murray PA, Vatner SF. (1980) Fractional contribution of the right and left coronary arteries to perfusion of normal and hypertrophied right ventricle of conscious dogs. Circ Res 47: 190–200PubMedGoogle Scholar
  14. 14.
    Urabe Y, Tomoike H, Ohzono K, Koyanagi S, Nakamura M. (1985) Role of afterload in determining regional right ventricular performance during coronary underperfusion in dogs. Circ Res 57: 96–104PubMedGoogle Scholar
  15. 15.
    Kusachi S, Nishiyama O, Yasuhara K, Saito D, Haraoka S, Nagashima H (1982) Right and left ventricular oxygen metabolism in open-chest dogs. Am J Physiol 234: H761–H766Google Scholar

Copyright information

© Springer-Verlag Tokyo 1988

Authors and Affiliations

  • Hitonobu Tomoike
  • Motoomi Nakamura
    • 1
  1. 1.Research Institute of Angiocardiology and Cardiovascular Clinic, Faculty of MedicineKyushu UniversityHigashi-ku, Fukuoka, 812Japan

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