Assuntos
Fístula Artério-Arterial , Aneurisma Coronário , Doença da Artéria Coronariana , Fístula , Cardiopatias Congênitas , Fístula Vascular , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Humanos , Artéria Pulmonar , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgiaRESUMO
BACKGROUND: Saphenous vein grafts (SVGs) are frequently used for multi-vessel coronary artery bypass grafting and peripheral arterial bypasses; however, the estimated 40% failure rate within the first 5 y due to intimal hyperplasia (IH) and the subsequent failure rate of 2%-4% per year pose a significant clinical problem. Here, we report a surgical model in sheep intended to study IH development in SVGs, which can also be used for the evaluation of potential alternative treatments. MATERIALS AND METHODS: Autologous bilateral SVGs were implanted as femoral artery interposition grafts using end-to-side anastomoses in adult sheep (n = 23), which were survived for 30 (n = 6), 90 (n = 7), 180 (n = 7), or 365 (n = 3) days. Post-implant, mid-term, and pretermination angiograms were quantified, and harvested SVGs were evaluated using quantitative histomorphometry. RESULTS: We describe a peripheral arterial surgical technique that models the progression of SVG pathology. Angiographic analysis showed a progressive dilation of SVGs leading to worsening diametrical matching to the target artery and reduced blood flow; and histomorphometry data showed an increase in IH over time. Multivariable regression analysis suggested that statistically significant (P < 0.05) time-dependent relationships exist between SVG dilation and both reduction in blood flow and IH development. CONCLUSIONS: Bilateral SVGs implanted onto the femoral arteries of sheep produced, controlled and consistent angiographic and histomorphometric results for which direct correlations could be made. This preclinical investigation model can be used as a robust tool to evaluate therapies intended for cardiovascular pathologies such as occlusive IH in SVGs.
Assuntos
Modelos Animais de Doenças , Artéria Femoral/cirurgia , Oclusão de Enxerto Vascular/patologia , Veia Safena/transplante , Carneiro Doméstico , Doenças Vasculares/cirurgia , Anastomose Cirúrgica/métodos , Animais , Ponte de Artéria Coronária , Feminino , Hiperplasia/patologia , Hiperplasia/cirurgia , Masculino , Coleta de Tecidos e Órgãos/métodos , Túnica Íntima/patologia , Túnica Íntima/cirurgia , Doenças Vasculares/patologiaRESUMO
The Commerson's dolphin (Cephalorhynchus commersonii) is an odontocete cetacean specie that lies in the waters of the southern hemisphere. With the aim of studying the course and distribution of Cephalorhynchus commersonii's coronary arteries, an exhaustive heart dissection was performed on one specimen. To the extent of our knowledge, and basing upon an extensive bibliographic research on the commersonii species, this is the first reported description of a Commerson's dolphin heart anatomy. Despite the fact that the analysis of a unique specimen does not allow to establish final conclusions, comparisons reveal broad similarities between Cephalorhynchus commersonii's coronary distribution and previous anatomical studies describing the heart of various marine diving mammals and the human fetus circulation. Diving mammals have developed an anastomotic system along evolution, in order to adjust their bodies to diving imposed conditions, and minimize the oxygen demand of the heart muscle. The present work begins with the identification of the patterns and similarities between Commerson's dolphin heart anatomy when compared to other odontecete species, to continue with an exhaustive description of the Commerson's dolphin coronary anatomy.
La tonina overa (Cephalorhynchus commersonii) es una especie de cetáceo odontoceto que se encuentra en las aguas del hemisferio sur. Con el objetivo de estudiar el curso y la distribución de las arterias coronarias de Cephalorhynchus commersonii, se realizó una disección exhaustiva del corazón de un ejemplar. Hasta donde sabemos, y basándonos en una extensa investigación bibliográfica sobre la especie, esta es la primera descripción informada de la anatomía de un corazón de este ejemplar. A pesar de que el análisis de una sola muestra no permite establecer conclusiones finales, las comparaciones revelan amplias similitudes entre la distribución coronaria de Cephalorhynchus commersonii, los estudios anatómicos previos que describen el corazón de varios mamíferos marinos buceadores, y la circulación del feto humano. Los mamíferos buceadores han desarrollado un sistema anastomótico a lo largo de la evolución para ajustar sus cuerpos a las condiciones impuestas por el buceo y minimizar la demanda de oxígeno del músculo cardíaco. El presente trabajo comienza con la identificación de los patrones y similitudes entre la anatomía del corazón de tonina overa en comparación con otras especies odontecetas, continuando con una descripción exhaustiva de la anatomía coronaria.
Assuntos
Animais , Vasos Coronários/anatomia & histologia , Golfinhos/anatomia & histologia , Coração/anatomia & histologiaRESUMO
The incidence of arrhythmias after acute myocardial infarction of the inferior wall varies with the affected segment and increases when there is right ventricular involvement. This paper provides a clear review of the blood supply to the conduction system and gives an anatomic explanation of that supply.We dissected 20 human hearts after anterograde and retrograde injection of latex. In every heart, we dissected the conduction system and its blood supply. Retrograde perfusion enabled proper injection of the atrial vessels that originate at the beginning of the coronary trunks.We describe the 4 main arteries that supply blood to the conduction system. The classic concept included the atrioventricular node artery and the 1st septal artery. To that we add Kugel's artery and the right superior descending artery.The incidence of arrhythmias after acute myocardial infarction of the inferior wall is greater when the occlusion of the coronary trunk is at or near the origin. This is due to the existence of the right superior descending artery, which is given off by the right coronary trunk less than 1 cm from the origin. The arrhythmias caused by the occlusion of the circumflex artery are due to the existence of Kugel's artery, which displays a peculiar anastomotic pattern.