Objective – ensuring protection of the myocardium in conditions of acute ischemia, using endovascular retrograde perfusion of oxygenated blood through the coronary sinus in the experiment.
Material and methods. In 2003, at the Bakoulev Center, in the experiment, under the guidance of N.A. Chigogidze developed an original technique for selective synchronized retrograde perfusion of the cardiac venous system, with artificially induced ischemia in the basin of the left coronary artery. Similar experiments were continued on 12 experimental pigs weighing 20–25 kg. In clinical settings, retrograde hemoperfusion using endovascular technology was used in 2 cases in patients suffering from coronary heart disease with ACS, with critical stenosis or occlusion of the AAD according to angiographic examination; a picture of acute myocardial ischemia recorded during a routine diagnostic study (ECG paper tape); a history of stable myocardial ischemia III–IV functional class according to the Canadian classification. Contraindications to the use of this method were: local narrowing of the coronary arteries up to 60% during angiographic examination, with no clinical signs of ischemia in history; type D and E location of the coronary veins according to the classification of M.V. Ludinghausen ejection fraction < 40%.
Results. In the experiment, the average time for the appearance of pronounced signs of myocardial ischemia without retrograde myocardial perfusion was 105 ± 25 seconds. Against the background of retrograde perfusion of blood myocardium, in 19 out of 22 cases, there was a complete disappearance of obvious signs of ischemia for an average of 4±1 min. In 3 cases, ischemia persisted. In the clinic, during the intervention, two patients underwent successful endovascular correction of clinically-determining lesions of the anterior coronary basin. During the coronary stenting procedure, no acute ischemic ECG changes or angina attacks were noted in either case.
Conclusion. Selective retrograde perfusion of oxygenated blood into the vein accompanying anterior descending artery can be used as a method of intraoperative support of cardio-hemodynamic parameters in acute ischemia, with obligatory observance of hemodynamic parameters
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About the authors
- Magomedrasul K. Musaev, Researcher, Acting Head of Department; ORCID
- Mikhail V. Avaliani, Dr. Med. Sci., Leading Researcher; ORCID
- Abdulgamid Yu. Musalov, Researcher, Endovascular Surgeon, Cardiovascular Surgeon; ORCID
- Valeriyan M. Lusparonyan, Endovascular Surgeon; ORCID
- Azamat M. Ardavov, Researcher, Endovascular Surgeon; ORCID
- Alimurat Z. Pashukov, Physician-Resident; ORCID