End-capillary loops in the heart: an explanation for discrete myocardial infarctions without border zones.

Separate perfusions of canine coronary arteries with colored silicone-rubber compound reveal that in the region where two microcirculations abut, capillaries derived from individual large vessels are discrete, with no interconnections. Terminal homologous capillaries from loops rather than anastomosing with heterologous capillaries. This anatomic arrangement may account for discrete myocardial infarctions without ischemic border zones.

The histological lateral border of acute canine myocardial infarction. A function of microcirculation.

Studies from this laboratory have shown that the border of a 24-hour canine infarct is histologically sharp and is composed of numerous interdigitating peninsulas of necrotic and normal tissue. To see if this sharp boundary is spatially related to the capillary beds of occluded and non-occluded arteries, the left anterior descending artery (LAD) was ligated in five mongrel dogs. Twenty-four hours later, white silicone rubber (Microfil) was injected into the LAD distal to the ligature; simultaneously and under the same pressure, red Microfil was injected into the left main coronary artery (LMCA). In hematoxylin and eosin sections from the border of the infarct, capillaries supplied by the LAD (white) were either in areas of necrosis, in normal epicardium or, rarely, in normal tissue along the lateral boundary; those supplied by the LMCA (red) were almost always in normal regions. Quantitative evaluation of this relationship revealed that the majority of the vessels in the normal and necrotic tissue were concordant (i.e., that normal tissue was supplied by the LMCA, and necrotic tissue by the LAD). However, a small zone of vascular discordance, averaging approximately 30 micrometers in width, was present along the infarct boundary, possibly representing a narrow border zone of little consequence. Hence, the complex interdigitation of normal and necrotic tissue in the lateral border of an infarct is predominantly a function of the interdigitation of the capillary beds supplied by the occluded and nonoccluded arteries.

The microcirculation of the human heart: end-capillary loops with discrete perfusion fields.

We studied 10 autopsied human hearts by perfusing colored Microfil into separate coronary arteries to define organization of capillaries at the borders between two perfusion fields. Sections of "cleared" myocardium were examined with epiillumination at the grossly identified borders of Microfil perfusion. In two- and three-color-injected hearts, the capillaries were arrayed in a pattern of arcades and loops without connections between separately perfused capillary beds. In hearts perfused through only one coronary artery, the capillaries were organized into tufted loops at the border. These findings contrast with the microcirculatory pattern in canine skeletal muscle and brain, in which heterologous capillaries are focally interconnected. We conclude that the human microcirculation is composed of end-capillary loops that supply discrete perfusion fields. This pattern of unconnected heterologous capillary beds suggest that there is no obvious anatomic arrangement of the microcirculation that could account for a significant ischemic lateral border zone in human myocardial infarctions.