Author + information
- Received May 16, 1991
- Revision received May 13, 1992
- Accepted May 19, 1992
- Published online November 15, 1992.
- Benjamin D. Robalino, MD, FACC∗,
- Thomas Marwick, MB, BS,
- Antoine Lafont, MD,
- Kevin Vaska, MD and
- Patrick L. Whitlow, MD, FACC∗
- ↵∗Address for correspondence: Patrick L. Whitlow, MD, Desk F-25, Cleveland Clinic Foundation, One Clinic Center, 9500 Euclid Avenue, Cleveland, Ohio 44195.
Objectives. The purpose of this report was to study the protective effects of passive and active distal coronary perfusion during prolonged balloon inflation.
Background. Prolonged balloon inflation has been proposed to improve immediate and long-term results of percutaneous transluminal coronary angioplasty, but it requires protection against myocardial ischemia.
Methods. A 30-min balloon occlusion of the left anterior descending artery was performed in three groups of closed chest anesthetized dogs: 1) control (no distal coronary perfusion, n = 13), 2) passive distal coronary perfusion (autoperfusion catheter, n = 10), and 3) active distal coronary perfusion (infusion of the perfluorochemical Fluosol at 30 ml/min, n = 11).
Results. At 10 min of balloon inflation, echocardiographic wall motion indexes (scored from 1 [normal] to 5 [dyskinesia]) in the autoperfusion catheter and Fluosol groups (2.4 ± 1.2 and 2.0 ± 0.9, respectively) were significantly better than in the control group (3.6 ± 0.4, p = 0.001), but at 25 min this improvement in wall motion had attenuated and became statistically insignificant when compared with values in the control group. Left ventricular end-diastolic pressure at peak inflation in the Fluosol group (19.5 ± 5.5 mm Hg) was higher than in the control (7.6 ± 3.6) and autoperfusion catheter (5.3 ± 1.4, p ≤ 0.01) groups. Pathologic evidence of infarction by tetrazolium staining was seen in three control dogs and in none of the other groups (p = 0.07). Ventricular tachycardia and fibrillation were less frequent in the autoperfusion catheter group (p = 0.02). Three deaths were observed in the control dogs, two in the Fluosol group and none in the dogs with an autoperfusion catheter (p = NS).
Conclusions. Passive (the autoperfusion balloon catheter) and active (Fluosol) distal coronary perfusion methods are comparable and better than no perfusion im protecting the myocardium against ischemia produced by prolonged coronary balloon inflation in an experimental canine model. This protection is transient, attenuating after 10 to 25 min, and partial because there was no significant diference in the incidence of myocardial infarction and death among groups, although the latter observations may be related to small sample size.
↵∗ Present address: 1801 South 5th Street, Suite 106, McAllen, Texas 78503.
☆ This study was supported in part by research grants from Baxter Healthcare Corporation, Irvine, Alpha Therapeutic Corporation, Los Angeles and Advanced Cardiovascular Systems, Santa Clara, California.
- Received May 16, 1991.
- Revision received May 13, 1992.
- Accepted May 19, 1992.