Distal vessel pullback angiography and pressure gradient measurement: an innovative diagnostic approach to evaluate the no-reflow phenomenon

Coronary no-reflow phenomenon

No-reflow occurs in up to one third of patients with acute myocardial infarction during acute percutaneous intervention, and occasionally during elective interventions, particularly vein graft intervention. Multiple intracoronary medications will restore flow in most cases. We begin with 100 to 1000 mg of nitroprusside, verapamil, or adenosine at a similar dosage. We give it at 100-mg increments at high velocity. We inject it distally in the epicardial artery to avoid any systemic effect, and we do it through an intracoronary perfusion catheter. At times, we use prophylactic injections (prior to balloon inflation), particularly in vein graft intervention. Most of these strategies are not formally approved for treating no-reflow. However, reversing this condition with restoration of normal coronary flow is essential for an improved left ventricular function and a better cardiac outcome.

A comparative study of Euro-Collins, low potassium University of Wisconsin and cold modified blood solutions in lung preservation in acute autotransplantations in the pig

OBJECTIVE

The aim of the study was to assess the quality of lung preservation offered by Euro-Collins solution (EC), Cold Modified Blood solution (CMB) and low potassium University of Wisconsin solution (UWLP).

METHOD

Fifteen right lung auto-transplantations (five for each solution) in the pig (Large White) were performed after 2 h of cold ischaemic storage in physiological solution at 4 degrees C. Right lung biopsies were performed before ischaemia and 30 min after reperfusion, for histoenzymatic, histopathological and electron microscope studies.

RESULTS

After reperfusion, significant alterations were observed in the haemodynamics with only the right lung perfused; pulmonary arteriolar resistance increased by a factor of 5 in the EC group, by a factor of 4 in the CMB group and by a factor of 1.2 in the UWLP group; the right ventricular ejection fraction fell by 60% in the EC group, by 50% in the CMB group and by 31% in the UWLP group. Haemodynamic impairment was lower in the UWLP group (P<0.05; P<0.001) as was ischaemic-reperfusion injury (P<0.05). Oedema was observed in the EC group and extensive alveolar wall damage in the CMB group. Hypoxaemia was observed in all groups but the differences in the degree of hypoxaemia were not significant.

CONCLUSIONS

The authors concluded that UWLP solution was the most effective of the three in this transplant model.