Coronary venous synchronized retroperfusion during percutaneous transluminal angioplasty of left anterior descending coronary artery.

Synchronized coronary venous retroperfusion was applied and studied in 16 patients undergoing percutaneous transluminal coronary angioplasty (PTCA) balloon dilatation of proximal left anterior descending (LAD) coronary artery stenosis. The rationale for using retroperfusion support during the PTCA-induced coronary artery occlusions was to ameliorate or prevent myocardial ischemia and possibly facilitate extension of the PTCA balloon-inflation period. After therapeutic PTCA treatment, which successfully dilated the culprit coronary artery in all 16 patients, and a 5-minute recovery period, a single retroperfusion-treated LAD occlusion (101 +/- 36 seconds) was compared with equivalent untreated control LAD occlusions (86 +/- 24 seconds) before and after the retroperfusion-supported balloon occlusion. Observations and measurements encompassed 1) ease and time of coronary sinus catheterization, 2) incidence of anginal pain during LAD occlusion, 3) electrocardiographic signs of myocardial ischemia, and 4) two-dimensional echocardiographic indexes of global left ventricular function. The coronary sinus was successfully catheterized within 139 +/- 140 seconds, and in 12 of the 16 patients, the tip of the special autoinflatable retroperfusion balloon catheter could be placed in the desired location of the great cardiac vein. The retroperfusion protocol interfered minimally with the PTCA procedure, and application of the support system had no deleterious effects. As compared with the pain reported 23 (72%) times during the 32 control LAD occlusions, only five (31%) of the patients indicated pain or discomfort during the retroperfused occlusions. Treated occlusions exhibited delayed or significantly lower electrocardiographic ST segment elevations (sum, 10.4 +/- 7.8 mm) as compared with the controls (sum, 16.2 +/- 7.9 mm and 18.8 +/- 10.6 mm; both p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)