Effects of coronary sinus pressure elevation on myocardial blood flow

Abstract

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The heart attack is still the most common cause of death in the western world. This study aims to provide scientific evidence of minimising myocardial infarct by implementing minimal invasive technique via catheterisation of the coronary sinus. Pressure Controlled Intermittent Coronary Sinus Occlusion (PICSO) is considered as a physiological way of salvaging myocardium at risk after myocardial infarction or even after intraoperative global arrest of the heart. The benefit of PICSO is assumed to result from cyclic occlusion and release of the coronary sinus shifting venous blood to underperfused redions.<br />Intermittent occlusion of the coronary sinus is achieved by the balloon occlusion system, which is driven pneumatically. In the study, important aspects were introduced for further understanding and consequent optimizing of PICSO treatment. This thesis revealed optimisation option for the release time, it indicated the cycles which mostly support salvage of myocardium, and showed that dynamics of CSOP can be used as diagnostic tools during the surgery. Computational modelling highlighted the importance of the venous channels connecting two coronary beds and clarified effects of their variation on capillary support in underprefused myocardial region. Experimental techniques and computational modelling brought us a step further in understanding of coronary circulation, pointing out a coronary venous monitoring as a valuable parameter to control changes in myocardial perfusion as they occur in revascularisation procedure