Effectiveness of Coronary Sinus Retroinfusion on the Acute myocardial Ischemia.

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To evaluate the effects of retrograde administration of diltiazem into the ischemic myocardium using synchronized retroperfusion system (SRP), mongrel dogs were anestherized and the left anterior descending coronary artery was occluded for 3.5 hours. A triple lumen balloon tipped catheter for SRP was positioned in the great cardiac vein via the coronary sinus. After 30 minutes of coronary occlusion, dogs were randomly assigned into following 4 groups.Group A (n=5) : Coronary occlusion was maintained for following 3 hours without any treatment.Group B (n=9) : Coronary occlusion was maintained for 3 hours with intravenous infusion of diltiazem (3ug/kg/min).Group C (n=8) : SRP was initiated with intravenous infusion of diltiazem (3ug/kg/min) for 3 hours.Group D (n=9) : SRP was initiated with intracoronary-venous infusion of diltiazem (3ug/kg/min), infused into the extracorporeal circuit of SRP system, for 3 hours.Hemodynamic change, blood and myocardial concentration of diltiazem and infa … More rct sized, estimated by triphenylterazolium method, as a percent of risk area (estimated by blue dye method) were measured.Results : There was significant reduction in heart rate and suppression of the rise of left ventricular enddiastolic pressure with the time of lapse in the groups treated with diltiazem (B,C,D). There were no significant differences between the groups in systolic left ventricular pressure, pulmonary blood pressure and cardiac output. Diltiazem concentrations in the venous blood and the myocardium ( endocardial layr (End), epicardial layr (Epi) in the ischemic (I) and non-ischemic (N)) were tabulated (mean(〕SY.+-.〔)S.E., ^<**>p<0.05 v.s. group B) :The infarcted size in the group D was significantly smaller (43.2(〕SY.+-.〔)3.1%) compared with the group A(77.5(〕SY.+-.〔)2.5%) and B (78.9(〕SY.+-.〔)7.6%)(group C was 52.7(〕SY.+-.〔)5.9%, n.s.). These data indicate that retroinfusion of diltiazem using retroperfusion system can deliver diltiazem into the ischemic myocardium and reduce ultimate infarct size. Less