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(Chest. 1973;63:462-463.)
© 1973 American College of Chest Physicians

Arterialization of the Coronary Vein Coming from an Ischemic Area

E. G. Arealis M.D.1; J. G. R. Volder M.D.1; and W. J. Kolff M.D.2

1 Salt Lake City
2 Division of Artificial Organs, Department of Surgery, University of Utah College of Medicine; Salt Lake City

These three preliminary experiments encourage the continuation of this work. If the results are conclusive in further investigations, this technique offers a new surgical approach for the treatment of coronary disease, especially when there is diffuse disease of the peripheral part of the coronary artery. The untouched venous system never suffers from sclerosis and is, therefore, always available.

The likelihood exists that the arterialized vein will develop sclerosis. If it does, this will take time and the candidates for the operation are in desperate need for immediate relief. Development of sclerosis will depend on the pressure generated in the venous branch.

This technique is easy to perform because the vein is larger than the artery and there is no preexisting narrowing at bifurcation of the branches as can occur in the artery. It requires only one operation, a thoracotomy, when the mammary artery is used. However, a saphenous vein graft might be used instead of the mammary artery. There should be no need for extracorporeal circulation, but if necessary, it would not be lengthy because using the mammary artery, only one anastomosis would be required.

Where does the blood go that we supply to the specific venous branch of the ischemic area? Either to the Thebesian veins or via anastomoses, to other branches of the coronary sinus. We propose to investigate this. Longterm recovery periods of experimental animals to study the ultimate fate of the vein and the affected myocardium are also needed.

We have just learned of a paper presented by Schultz and colleagues in Amsterdam, April 1972. The conclusion was that retrograde venous perfusion is capable of acutely maintaining aerobic myocardial metabolism. We stress the advantage and simplicity of perfusing only the vein that derives from the ischemic area.




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