Cardiac vein myocardial revascularization. An experimental study and report of 3 clinical cases.

The feasibility of utilizing the coronary venous system for myocardial revascularization was explored in 18 dog experiments and 3 clinical patients at St. Mary Medical Center. Experimental models were developed using mammary artery-to-coronary vein anastomoses, free vein grafts from the aorta to the coronary veins, and saphenous vein bypass grafts from the aorta to the cardiac veins in the patients. Evaluation of myocardial revascularization was done by one or more of the following methods: (1) electromagnetic flowmeter measurements of graft blood flow; (2) myocardial scanning after injection of radioactive materials; (3) hydrogen electrode evaluation of arteriovenous shunting; (4) coronary cineangiograms; (5) methylene blue injections with visual observation of myocardial staining and collateral venous pathways; (6) pulse-flow tracings; (7) electrocardiographic changes; and (8) myocardial venous capillary response to papaverine and isoproterenol. The experimental studies consistently demonstrated evidence of myocardial revascularization through the coronary venous system. Three patients with intractable angina pectoris and previous unsuccessful revascularization procedures underwent saphenous vein bypass grafting from the aorta to the coronary vein. Postoperative coronary cineangiograms showed patency in 2 of 4 grafts. Myocardial scanning demonstrated radioactivity in the regions served by the patent grafts. All patients survived and were partially or completely relieved of their symptoms.