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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2011 February;52(1):127-31

language: English

Enhancement of non-coronary collateral blood flow from the internal thoracic arteries: the theoretical and practical basis of an alternative method of myocardial blood supplì

Picichè M. 1, Kingma Jr. J. G. 2, Fadel E. 3, Dagenais F. 1, Mathieu P. 1, Simard D. 2, Demaria R. G. 4, Voisine P. 1

1 Department of Cardiac Surgery, Laval University Hospital, Québec City, QC, Canada;
2 Research Center, Laval University Hospital, Québec City, QC, Canada;
3 Department of Thoracic and Vascular Surgery and Heart Lung Transplantation, Marie Lannelongue Hospital, Paris Sud University
Paris, France;
4 Department of Cardiovascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France


Non-coronary collateral blood flow arrives to the heart from mediastinal, bronchial, and pericardial channels. These enter the heart through the pericardial reflections surrounding the pulmonary and systemic veins, as well as from the vasa vasorum of the aorta and the pulmonary artery leading to and from the myocardium. Before the advent of cardiopulmonary bypass surgery, surgical bilateral ligature of the internal thoracic arteries (ITAs) was performed in patients with ischemic heart disease to increase the perfusion pressure within the channels leading to the heart. Nowadays, the occurrence of natural collaterals between coronary and extracardiac arteries including the ITAs, the potential hemodynamic effects of ITA ligation, the potential of ITAs for developing important collateral branches, and the current availability of angiogenic growth factors could pave the way for the development of a new field in cardiovascular research aimed at developing an alternative strategy of myocardial blood supply by means of the surgical and biological enhancement of non-coronary collateral circulation.

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