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Embolization of the internal thoracic arteries in refractory angina
International Journal of Cardiology 212 (2016) 310
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Correspondence
Embolization of the internal thoracic arteries in refractory angina Marco Picichè Cardiac Surgery Department, San Camillo - Forlanini Hospital, Circonvallazione Gianicolense 87, 00152 Rome, Italy
a r t i c l e
i n f o
Article history: Received 4 March 2016 Accepted 20 March 2016 Available online 24 March 2016 Keywords: Refractory angina Internal thoracic arteries Embolization
Glover' data confirmed Battezzati's encouraging results and the clinical value of the technique [5]. Currently, not all patients suffering from ischemic heart disease benefit from conventional myocardial revascularization techniques; and it is in this context that the concept of ITA occlusion has been promoted again since 2010 [6–9]. In man, transitory angioplasty balloon ITA occlusion increases the collateral flow index by means of a functional ischemia-reducing extra-cardiac coronary artery supply, via natural ipsilateral ITA bypasses [10]. This new achievement paves the way to further investigations regarding the effects of stable ITA occlusion, and reinforces the recent hypothesis [11] that endovascular embolization might be considered for otherwise untreatable patients. Conflict of interest
I read with great interest the article by Ielasi and associates [1] and congratulate them for resurrecting an interesting concept from the nineteen thirties and forties [2,3]. Old experiments by Mercier Fauteux had shown that after the great coronary vein had been ligated, circulatory re-adjustments occurred in the coronary system which allowed dogs to survive subsequent ligation of the left anterior descending artery. The experimental findings were such as to suggest that venous occlusion would be of considerable value in the treatment of advanced coronary disease in humans. On April 19, 1939, the first case was operated upon at the Royal Victoria Hospital, the patient remaining entirely free from angina for the following two years [2]. Besides the narrowing of the coronary sinus, at that time other methods had been invented to achieve relief from angina, such as the occlusion of the internal thoracic arteries (ITAs). The belief was that mid-distal bilateral ligation of the ITAs would shunt flow back to the heart through the pericardiophrenic branches, by creating localized hypertension above the obstruction and increasing perfusion pressure in channels leading to the heart [3,4]. Surgical access consisted of a small, bilateral incision between the second and the third rib. Many patients operated upon with this technique reported relief from their angina. In 1959 Battezzati et al. reported very encouraging results in the Am J Cardiology on 304 patients [4]. He saw symptomatic improvement in 94.8% of the patients and electrocardiogram improvement in 64.1%. The authors concluded that surgical ligation of the ITA produced “an increased blood supply to the myocardium through natural and pre-existing anastomotic channels”. In Philadelphia, Glover demonstrated that ligation of the ITAs prior to coronary artery occlusion prevented many dogs from dying, whereas all dogs died within 24 h in the group in which coronary occlusion was not preceded by ITA ligation [5]. Specifically, 58% of the dogs in the legated group survived five days or more and 36% recovered completely. In humans, E-mail address: [email protected].
http://dx.doi.org/10.1016/j.ijcard.2016.03.156 0167-5273/© 2016 Elsevier Ireland Ltd. All rights reserved.
The authors report no relationships that could be construed as a conflict of interest. References [1] A. Ielasi, M.C. Todaro, G. Grigis, M. Tespili, Coronary Sinus Reducer system: a new therapeutic option in refractory angina patients unsuitable for revascularization, Int. J. Cardiol. 209 (2016) 122–130. [2] M. Fauteux, J.H. Palmer, Treatment of angina pectoris of atheromatous origin by ligation of great cardiac veins, Can Med Assoc J 45 (1941) 295–299. [3] M. Picichè, The history of myocardial revascularization before the advent of cardiopulmonary bypass, in: M. Picichè (Ed.), Dawn and Evolution of Cardiac Procedures: Research Avenues in Cardiac Surgery and Interventional Cardiology, SpringerVerlag, Heidelberg 2012, pp. 65–77. [4] M. Battezzati, A. Tagliaferro, A.D. Cattaneo, Clinical evaluation of bilateral internal mammary artery ligation as treatment coronary heart disease, Am. J. Cardiol. 4 (1959) 180–183. [5] R.P. Glover, J.R. Kitchell, R.H. Kyle, J.C. Davila, R.G. Trout, Experiences with myocardial revascularization by division of the internal mammary arteries, Chest 33 (1958) 637–657. [6] M. Picichè, Noncoronary collateral myocardial blood flow: the human heart's forgotten blood supply, Open Cardiovasc. Med. J. 9 (2015) 105–113. [7] M. Picichè, E. Fadel, J.G. Jr Kingma, et al., Blood flow to the heart from noncoronary arteries: an intriguing but challenging research field, Cardiovasc Revasc Med 13 (2012) 25–29. [8] M. Picichè, J.G. Kingma, E. Fadel, et al., Enhancement of non-coronary collateral blood flow from the internal thoracic arteries: the theoretical and practical basis of an alternative method of myocardial blood supply, J. Cardiovasc. Surg. (Torino) 52 (2011) 127–131. [9] M. Picichè, J.G. Kingma, E. Fadel, et al., Enhancement of noncoronary collateral circulation: the hypothesis of an alternative treatment for ischemic heart disease, Med Hypotheses 74 (2000) 21–23. [10] M. Stoller, S.F. de Marchi, C. Seiler, The function of natural internal mammary-tocoronary artery bypasses and its effect on myocardial ischemia, Circulation 129 (2014) 2645–2652. [11] M. Picichè, J.G. Kingma, P. Voisine, F. Dagenais, E. Fadel, Angiogenesis and surgical or endovascular enhancement of noncoronary collateral circulation: a new research field, J Thorac Cardiovasc Surg 139 (2010) 1675–1676.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Correspondence
Embolization of the internal thoracic arteries in refractory angina Marco Picichè Cardiac Surgery Department, San Camillo - Forlanini Hospital, Circonvallazione Gianicolense 87, 00152 Rome, Italy
a r t i c l e
i n f o
Article history: Received 4 March 2016 Accepted 20 March 2016 Available online 24 March 2016 Keywords: Refractory angina Internal thoracic arteries Embolization
Glover' data confirmed Battezzati's encouraging results and the clinical value of the technique [5]. Currently, not all patients suffering from ischemic heart disease benefit from conventional myocardial revascularization techniques; and it is in this context that the concept of ITA occlusion has been promoted again since 2010 [6–9]. In man, transitory angioplasty balloon ITA occlusion increases the collateral flow index by means of a functional ischemia-reducing extra-cardiac coronary artery supply, via natural ipsilateral ITA bypasses [10]. This new achievement paves the way to further investigations regarding the effects of stable ITA occlusion, and reinforces the recent hypothesis [11] that endovascular embolization might be considered for otherwise untreatable patients. Conflict of interest
I read with great interest the article by Ielasi and associates [1] and congratulate them for resurrecting an interesting concept from the nineteen thirties and forties [2,3]. Old experiments by Mercier Fauteux had shown that after the great coronary vein had been ligated, circulatory re-adjustments occurred in the coronary system which allowed dogs to survive subsequent ligation of the left anterior descending artery. The experimental findings were such as to suggest that venous occlusion would be of considerable value in the treatment of advanced coronary disease in humans. On April 19, 1939, the first case was operated upon at the Royal Victoria Hospital, the patient remaining entirely free from angina for the following two years [2]. Besides the narrowing of the coronary sinus, at that time other methods had been invented to achieve relief from angina, such as the occlusion of the internal thoracic arteries (ITAs). The belief was that mid-distal bilateral ligation of the ITAs would shunt flow back to the heart through the pericardiophrenic branches, by creating localized hypertension above the obstruction and increasing perfusion pressure in channels leading to the heart [3,4]. Surgical access consisted of a small, bilateral incision between the second and the third rib. Many patients operated upon with this technique reported relief from their angina. In 1959 Battezzati et al. reported very encouraging results in the Am J Cardiology on 304 patients [4]. He saw symptomatic improvement in 94.8% of the patients and electrocardiogram improvement in 64.1%. The authors concluded that surgical ligation of the ITA produced “an increased blood supply to the myocardium through natural and pre-existing anastomotic channels”. In Philadelphia, Glover demonstrated that ligation of the ITAs prior to coronary artery occlusion prevented many dogs from dying, whereas all dogs died within 24 h in the group in which coronary occlusion was not preceded by ITA ligation [5]. Specifically, 58% of the dogs in the legated group survived five days or more and 36% recovered completely. In humans, E-mail address: [email protected].
http://dx.doi.org/10.1016/j.ijcard.2016.03.156 0167-5273/© 2016 Elsevier Ireland Ltd. All rights reserved.
The authors report no relationships that could be construed as a conflict of interest. References [1] A. Ielasi, M.C. Todaro, G. Grigis, M. Tespili, Coronary Sinus Reducer system: a new therapeutic option in refractory angina patients unsuitable for revascularization, Int. J. Cardiol. 209 (2016) 122–130. [2] M. Fauteux, J.H. Palmer, Treatment of angina pectoris of atheromatous origin by ligation of great cardiac veins, Can Med Assoc J 45 (1941) 295–299. [3] M. Picichè, The history of myocardial revascularization before the advent of cardiopulmonary bypass, in: M. Picichè (Ed.), Dawn and Evolution of Cardiac Procedures: Research Avenues in Cardiac Surgery and Interventional Cardiology, SpringerVerlag, Heidelberg 2012, pp. 65–77. [4] M. Battezzati, A. Tagliaferro, A.D. Cattaneo, Clinical evaluation of bilateral internal mammary artery ligation as treatment coronary heart disease, Am. J. Cardiol. 4 (1959) 180–183. [5] R.P. Glover, J.R. Kitchell, R.H. Kyle, J.C. Davila, R.G. Trout, Experiences with myocardial revascularization by division of the internal mammary arteries, Chest 33 (1958) 637–657. [6] M. Picichè, Noncoronary collateral myocardial blood flow: the human heart's forgotten blood supply, Open Cardiovasc. Med. J. 9 (2015) 105–113. [7] M. Picichè, E. Fadel, J.G. Jr Kingma, et al., Blood flow to the heart from noncoronary arteries: an intriguing but challenging research field, Cardiovasc Revasc Med 13 (2012) 25–29. [8] M. Picichè, J.G. Kingma, E. Fadel, et al., Enhancement of non-coronary collateral blood flow from the internal thoracic arteries: the theoretical and practical basis of an alternative method of myocardial blood supply, J. Cardiovasc. Surg. (Torino) 52 (2011) 127–131. [9] M. Picichè, J.G. Kingma, E. Fadel, et al., Enhancement of noncoronary collateral circulation: the hypothesis of an alternative treatment for ischemic heart disease, Med Hypotheses 74 (2000) 21–23. [10] M. Stoller, S.F. de Marchi, C. Seiler, The function of natural internal mammary-tocoronary artery bypasses and its effect on myocardial ischemia, Circulation 129 (2014) 2645–2652. [11] M. Picichè, J.G. Kingma, P. Voisine, F. Dagenais, E. Fadel, Angiogenesis and surgical or endovascular enhancement of noncoronary collateral circulation: a new research field, J Thorac Cardiovasc Surg 139 (2010) 1675–1676.