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Ann Thorac Surg 1976;21:405-411
© 1976 The Society of Thoracic Surgeons

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Articles

Retrograde Coronary Capillary Perfusion for Prevention and Reversal of Cardiogenic Shock in Experimental Myocardial Infarction

From the Sections of Cardiothoracic Surgery and Cardiology, Temple University Health Sciences Center, Philadelphia, PA.

Accepted for publication September 3, 1975.

^* Address reprint requests to Dr. Lemole, Section of Cardiothoracic Surgery, Temple University Health Sciences Center, Philadelphia, PA 19140.

The coronary sinus and coronary veins offer an access route for delivery of increased oxygen to ischemic myocardium surrounding the central dead zone of heart muscle in cardiogenic shock due to myocardial infarction. This investigation was conducted to determine if transvenous retrograde coronary capillary perfusion with oxygenated blood would prevent and reverse cardiogenic shock in experimental myocardial infarction produced by acute ligation of the circumflex and anterior descending left coronary artery in dogs.

Cardiac output and systemic blood pressure were maintained near control values for up to 30 minutes when total left coronary ligation was accompanied by coronary retroperfusion. Conversely, both cardiac output and systemic blood pressure fell to severe cardiogenic shock levels within 2 minutes of total left coronary artery occlusion without retrograde flow or when retrograde flow was terminated 5 to 30 minutes following simultaneous coronary ligation and institution of retrograde flow. All animals undergoing left coronary ligation without retrograde flow died within 5 minutes from ventricular fibrillation, while this occurred in only 1 of 10 animals in which retrograde flow was started simultaneously with coronary occlusion. Cardiogenic shock was reversed by coronary retrograde perfusion in each of the 2 experiments in which this could be tested; oxygen was extracted by the myocardium from blood passing retrograde through the coronary capillaries.

It is concluded that coronary retrograde flow will maintain cardiac pump performance and prevent the development of cardiogenic shock following experimental left anterior descending and circumflex coronary artery occlusion in the working canine heart.

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