Great cardiac vein aspiration for refractory LAD No-reflow : A hypothesis waiting for proof.
Preamble The resting coronary blood flow (CBF) is about 5 % of cardiac output. It amounts to 250 ml /min (0.8 ml /mt/gram of myocardium ) It is estimated, blood flow across LAD is 50% . LCX and RCA share 25% each, depending upon the dominance. No need to say , the net return to coronary sinus should match the CBF at rest or exertion.(Minus a small fraction contributed by thebesain and vene cardia minimi flow, into the right heart chambers)Great cardiac vein (GCV) is the venous cousin of LAD. It must receive and empty 125ml of deoxygenated blood every minute into the coronary sinus, if LAD flow is normal. When LAD microcirculation is obstructed as in severe obstruction , GCV will fill and empty sluggishly. Let us move on from physiology to bedside.Primary PCI & No -reflow in LAD We have painfully realized, no-reflow is almost a hemodynamic death sentence to the concerned coronary artery during primary PCI. For practical purposes, no-reflow is common in left coronary circulation, that too in LAD. Decades of research and experience haven’t really helped us to either overcome or treat this complication effectively.
So, it’s worth considering experimental mechanical options.
The first option is, to forcibly open the closed microvasculature by pushing the debris across arterioles, venous capillaries and subsequently to the coronary sinus. This appears tricky as the high-pressure injection can be hazardous. This can be done either hand or...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized coronary sinus aspiration great cardiac vein aspiration for no reflow microvascular obstruction retrograde thrombus aspiration for no reflow Source Type: blogs
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