Prostaglandin E1 coronary venous retroperfusion in acute myocardial ischemia: effects on regional left ventricular function and infarct size

Prostaglandin E1was administered by means of coronary venous synchronized retroperfusion and the effectiveness of the combined (prostaglandin-retroperfusion) system was examined during acute myocardial Ischemia in 10 closed chest anesthetized dogs. Such treatment was administered between 30 minutes and 3 hours after occlusion of the proximal left anterior descending coronary artery. An equivalent series of 10 dogs with arterial blood retroperfusion alone and 9 untreated dogs served as control subjects. Standardized two-dimensional echocardiographic measurements of global and regional left ventricular function were performed in five short-axis cross sections. The global low left ventricular section and its profoundly ischemic anterolateral region exhibited distinctly improved systolic fractional area changes as a result of the prostaglandin E1retroperfusion treatment between 30 minutes and 3 hours after occlusion (22.9 ± 1.5to41.2 ± 4.0% and 1.8 ± 3.6 to 29.4 ± 5.6%, respectively). In contrast, further deterioration in function was noted during an untreated equivalent coronary occlusion period (16.3 ± 2.7 to 10.0 ± 3.3% and 12.6 ± 6.1 to 4.1 ± 6.9%). Although arterial blood retroperfusion alone provided distinct benefits in the ischemic region of a midpapillary echo section (from 13.4 ± 3.9 to 32.1 ± 10.4%, p < 0.05), no improvements were observed in profoundly jeopardized segments at the low left ventricular level (5.6 ± 6.0 to 0.9 ± 5.7%).Triphenyltetrazolium chloride delineation of infarction revealed significant myocardial salvage with prostaglandin E, retroperfusion as compared with findings in untreated control dogs (3.7% ± 1.3% of the left ventricle versus 9.3 ± 1.9%, p < 0.05). The respective ratios of necrosis to glycogen-depleted ischemic zones in a mid-left ventricular slab were 19.5 ± 6.4% versus 47.1 ± 8.9 (p < 0.05).It is concluded that retrograde prostaglandin E, administration may further enhance the effectiveness of synchronized coronary venous retroperfusion treatment of jeopardized acutely ischemic myocardium.