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Ann Thorac Surg 2000;69:1984
© 2000 The Society of Thoracic Surgeons

Correspondence

Ameroid constrictor versus hydraulic occluder: creation of hibernating myocardium

Patrick W. Domkowski, MD, PhDa, G. Chad Hughes, MDa, James E. Lowe, MDa

a Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA

To the Editor

We read with interest the recent article by Horvath and colleagues describing the upregulation of vascular endothelial growth factor (VEGF) mRNA and angiogenesis at 6 weeks after transmyocardial laser revascularization in the September 1999 issue of The Annals of Thoracic Surgery [1]. The authors showed that the VEGF mRNA levels are significantly increased in laser-treated animals. However, the authors reference a recent article by Hughes and associates in the August 1999 issue of The Annals stating that an "ameroid constrictor" was used to create hibernating myocardium in a porcine model [2]. This reference is incorrect. While we do have a reproducible model of hibernating myocardium, it is not achieved with an ameroid constrictor. Our chronic porcine model of hibernating myocardium employs a hydraulic occluder, designed by our laboratory, to gradually reduce coronary artery blood flow by 90% of baseline over a 3-day interval after the initial surgery. This reduction in blood flow is documented daily using an ultrasonic flow probe. Similar to Horvath and colleagues, we also use dobutamine stress echocardiography (DSE) to confirm hibernation, however, in addition we employ positron emission topography (PET). Our laboratory specifically did not use an ameroid constrictor. A major limitation of the ameroid constrictor is centered around the contraction-flow mismatch that often occurs after complete occlusion and subsequent coronary collateralization. While the rate of occlusion is gradual (2 to 3 weeks) and eventually complete, resulting in reduced coronary flow, Harada and colleugues have previously demonstrated that resting coronary blood flow often returns to baseline through collateral vessels after approximately 3 to 4 weeks of total occlusion with the ameroid constrictor [3]. Baseline echocardiography demonstrates no wall motion abnormality at rest.

In our experience of over 200 pigs using the hydraulic occluder technique, the hibernating area of myocardium is consistently reducible by DSE and PET. A significant wall motion abnormality is consistently seen at rest and stress in the circumflex distribution. The model paper is currently in press in The Annals by St. Louis and associates [4].

References

  1. Horvath K.A., Chiu B.S., Maun D.C., et al. Up-regulation of vascular endothelial growth factor mRNA and angiogenesis after transmyocardial laser revascularization. Ann Thorac Surg 1999;68:825-829.[Abstract/Free Full Text]
  2. Hughes G.C., Kypson A.P., St. Louis J.D., et al. Improved perfusion and contractile reserve after transmyocardial laser revascularization in a model of hibernating myocardium. Ann Thorac Surg 1999;67:1714-1720.[Abstract/Free Full Text]
  3. Harada K., Grossman W., Freidman M., et al. Basic fibroblast growth factor improves myocardial function in chronically ischemic porcine hearts. J Clin Invest 1994;94:623-630.
  4. St. Louis J.D., Hughes G.C., Kypson A.P., et al. An experimental model of chronic myocardial hibernation. Ann Thorac Surg 2000;69:1351-1357.[Abstract/Free Full Text]



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This Article
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