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Gas exchange in the pulmonary collateral circulation of dogs. Effects of alveolar hypoxia and systemic hypoxemia.

The left main pulmonary artery was ligated in 7 fully grown dogs. This resulted in an enlarged pulmonary collateral (systemic) flow to the left lung. By collecting gas from each lung separately, gas exchange in the pulmonary collateral circulation was studied and compared to that in the normal contralateral side. Studies were done repeatedly during a period of 3 years. Compared to that in the preoperative period, the ligated (left) side showed a decrease in ventilation (42.5 to 34.5 per cent of total), a marked increase in wasted ventilation (0.30 to 0.55), and a marked decrease in O2 uptake (45 to 11.2 per cent of total) and CO2 production (27.5 to 15.3 per cent of the total). There were no changes in arterial blood gases or pH. A significant, sustained, systemic hypertension was noted in all dogs in which the left main pulmonary artery was ligated (190/120). The mean blood flow through the pulmonary collateral circulation of the left lung with the dogs breathing room air was estimated to be 94 ml per min. When the dogs were made hypoxemic by breathing 12 per cent O2 through the normal right lung, there was a marked increase in pulmonary collateral (systemic) flow to the contralateral side (194 ml per min). This resulted in an increase in O2 consumption (29.4 per cent of total) and CO2 production (23.1 per cent of total) of the left lung. When the dogs were given 12 per cent O2 to breathe through the ligated left lung, there was no change in arterial PO2. There was a significant increase in blood flow through the pulmonary collateral circulation to 136 ml per min. Because of the gradient of O2 between the blood flowing into the left lung and that present in the alveoli, there was a net production of O2 from the left lung of 4.5 ml per min. When the pulmonary systemic circulation participates in gas exchange, it appears to increase during hypoxemia as well as during alveolar hypoxia.

Animals↗

Effect of aging on collateral circulation via pial anastomoses in cats.

The effect of aging on collateral circulation via pial anastomoses after middle cerebral artery occlusion was investigated in young and aged cats. The reduction of blood flow and electroencephalography power were greater and collateral vessel resistance was higher in the aged group than the young group. Electroencephalography power after the occlusion was correlated with collateral resistance and blood flow in the two groups. These results suggest that collateral function deteriorates with aging and the high vulnerability to ischemic insult in aged brain may be caused in part by the poor collateral function.

Aging↗

Ameroid constriction of the proximal left circumflex coronary artery in swine. A model of limited coronary collateral circulation.

Gradual narrowing and occlusion of a coronary artery in patients with atherosclerotic heart disease frequently causes enlargement of the collateral circulation. Although these vessels may protect from development of myocardial infarction, they frequently do not supply sufficient blood flow to prevent ischemia during periods of augmented myocardial oxygen demand. The purpose of this study was to develop a model of the collateral circulation in pigs, a species that previously has been shown to develop sparse collateral vessels. Eighteen pigs were instrumented with an Ameroid constrictor around the proximal left circumflex artery and left atrial and aortic catheters. In four animals the constrictor was placed just distal to a large proximal obtuse marginal vessel. Seven of the pigs were treated daily with oral aspirin (325 mg) and disopyramide (200 mg) throughout the study; the other 11 served as controls. After an average of 24 days postoperatively, radioactive microspheres were injected at rest, during exercise (mean heart rate = 245 beats/min), and during intravenous infusion of dypridamole (700 micrograms/kg). At autopsy the extent of necrosis was assessed by a point counting technique in the bed at risk. We found that 75-83% of the bed at risk remained viable. Although aspirin and disopyramide did not significantly alter the extent of infarction (37 +/- 36% untreated vs 17 +/- 6% treated), there was less variability of infarction in the treated group, and subendocardial blood flow during exercise was higher in the treated group compared to controls. The majority of infarction occurred in the subendocardial region. Animals with a large obtuse marginal branch developed significantly smaller infarcts (8 +/- 3%).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

[The collateral circulation due to cerebral arterio-venous malformation and occlusions of major cranial vessels (author's transl)].

Arteriovenous malformations (AVM) of the brain are diagnosed mostly in the early adult life. With the come up of Computerized Tomography (CT) which often is done without the strong indications as postulated for the conventional neuroradiologic examinations, asymptomatic AVM in the elderly population may be found. Since May 1977 4 asymptomatic arteriovenous malformations were diagnosed in our institution using CT. 2 of these patients had severe degenerative changes of the great cerebral vessels and an unusual collateral circulation developed probably because of the steal-phenomenon in the vascular malformation. These 2 cases allow to study all possibilities of cerebral collateral circulation. Uncommon in one of the cases was a capillary anastomotic network through the thalami, in the other case an extensive dural rete mirabile developed. The problems of collateral circulation are discussed.

Cerebral Angiography↗

Collateral circulation in total occlusion of the left anterior descending or right coronary artery.

The functional significance of the collateral circulation was evaluated in 125 patients with total coronary occlusion. Patients were classified into two groups. Group 1:patients with angina pectoris (AP), Group 2:patients with a first transmural myocardial infarction (MI) within 3 months of the symptom onset. Clinical variables, resting and exercise electrocardiogram (EKG) were analyzed with angiographic findings. Collateral fillings were graded from 0 to 3: 0 = none; 1 = filling of side branches only; 2 = partial filling of the epicardial segment; 3 = complete filling of epicardial segment. The wall motion of each segment was scored from 1 to 5: 1 = normal; 2 = mild to moderate hypokinesia; 3 = severe hypokinesia; 4 = akinesia; 5 = dyskinesia. The scores of the 5 segments were added to yield a total LV score. There was a higher prevalence of good collaterals and multi-vessel disease in patients with AP than in those with MI (83% vs 53%, 54% vs 30%, respectively, p < 0.005). The left ventricular ejection fraction (LVEF), left ventricular end-diastolic pressure (LVEDP) and segmental wall motion score were significantly better in patients with AP than in those with MI (68.9 +/- 13.4%, vs 50.5 +/- 12.6%, 15.0 +/- 7.3 mmHg vs 20.3 +/- 8.8 mmHg, 6.5 +/- 2.2 vs 9.6 +/- 2.3, respectively, p < 0.05). In spite of total coronary occlusion, 61% of AP patients had normal resting EKG but (96% of AP patients who underwent treadmill test proved positive. The proportions of well-developed collaterals in 3 groups divided according to the interval between onset of MI and angiography (within 1 day, 2 to 14 days, 15 days to 3 months) were 13%, 54% and 60%. There were no significant differences in LVEF, segmental wall motion score and LVEDP in MI patients with poorly-developed collaterals and well-developed collaterals (49.1 +/- 15.7% vs 46.4 +/- 10.1%, 11.1 +/- 2.2 vs 10.9 +/- 1.4 and 24.3 +/- 9.7 mmHg vs 20.3 +/- 7.0 mmHg, p = NS). The degree of collateral development was higher in MI with right coronary artery occlusion compared with that of left anterior descending artery occlusion (1.1 +/- 1.0 vs 2.0 +/- 1.0, p < 0.05). In conclusion, collateral circulation can prevent myocardial ischemia and preserve myocardial function in a significant number of patients with AP but do not provide protection against exercise-induced myocardial ischemia in the majority of patients with AP.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

[Collateral circulation via the arterial network of the neck in subclavian artery occlusion].

The authors describe three different varieties of collateral circulation via the so called arterial network of the nape of the neck in patients with proximal subclavian artery occlusion. Attention is called to the importance of cervical veins visualization for the evaluation of the efficiency of the collateral circulation and prognosis about the further state of the patient. The authors propose a modification of angiography with additional films taken of the subclavian area in late arterial phase making possible to demonstrate the site of subclavian artery occlusion during carotid angiography.

Adult↗

[Effect of puerarin on coronary collateral circulation in dogs with experimental acute myocardial infarction].

OBJECTIVE: To evaluate the effect and mechanism of puerarin on coronary collateral circulation in dogs with experimental acute myocardial infarction. METHOD: Twelve dogs were randomly divided into puerarin (Gegen su, G) group and control(C) group, the acute myocardial infarction model was built in all dogs. Puerarin or saline was administered for 21 days. Coronary angiography was performed before and after ligating coronary artery. The capillaries and distribution vessel density in tissue sections of myocardium were assessed. RESULT: Angiography on hour 2 and day 22 after ligating coronary artery revealed significant augmentation of collateral vessels in G group versus controls. Capillaries and distribution vessel density in ischemic and infarctive zone on day 22 revealed statistically significant augmentation in G group versus controls (P < 0.05 and P < 0.01). CONCLUSION: Puerarin might improve the opening and forming of coronary collateral circulation to ischemic myocardium in dogs and protect ischemic myocardium.

Animals↗

[The relationship of the indices of intracranial collateral circulation to variants in the clinical course of acquired high myopia].

Relationship between visual functions, status of the fundus oculi, electrophysiological parameters, morphodensitometric parameters of the intraorbital part of the optic nerve, and linear bloodflow velocity (LBV) in intracranial vessels is studied in 78 patients (156 eyes) with acquired high myopia. A less than 20% decrease of LBV in intracranial vessels correlates with high visual functions. A more than 40% decrease of LBV in the anterior, median, and posterior arteries of intracranial collateral circulation correlates (r = 0.56) with the presence of central and peripheral chorioretinal dystrophy. A more than 40% decrease of LBV in the basal, vertebral, and posterior cerebral arteries of transcranial collateral circulation closely correlates (r = 0.7) with signs characteristic of partial optic nerve atrophy. The development of complications of acquired high myopia apparently depends on the deficiency of various components of collateral cerebral circulation.

Adult↗

Evaluation of collateral circulation of the hand.

In 1929, Edgar V. Allen described a noninvasive evaluation of the patency of the arterial supply to the hand of patients with thromboangitis obliterans (Am J Med Sci 1929; 178:237). In the early 1950s, Allen's test was modified (Wright I. Vascular diseases in clinical practice. Chicago: Year Book Medical Publishers, 1952) for use as a test of collateral circulation prior to arterial cannulation. This test involves the examiner occluding the patient's ulnar and radial arteries while the patient makes a fist, causing the hand to blanch. The patient is then asked to extend the fingers. After the hand is open, the examiner releases the ulnar artery while continuing to maintain pressure on the radial artery. Adequate collateral circulation is felt to be indicated by return of normal color to the hand. The patient is instructed not to hyperextend the fingers when opening the hand. Hyperextension may cause a decrease in perfusion to the arch, possibly resulting in a false interpretation of the Allen test (Anesthesiology 1972;37:356). The modified Allen's test can be performed quickly and easily, but it is susceptible to error. (With Allen's original test, both hands were tested simultaneously. The patient clenched both fists tightly for 1 minute while the examiner compressed one artery of each hand. This method helps diagnose complete occlusion, just as Allen intended. The test was later modified, however, to evaluate the adequacy of collateral circulation. To perform the modified Allen's test, the examiner compresses both arteries while the patient's fist are clenched.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Collateral circulation in the rabbit tongue after common carotid ligation.

A study was undertaken to ascertain the microvascular pattern of the collateral circulation of the tongue after unilateral ligation of the common carotid artery. The right common carotid artery was ligated in 25 New Zealand White male rabbits. These animals were killed in groups of five at intervals of an hour, six hours, 24 hours, one week, and two weeks. The vasculature in the head and neck of these animals was flushed with heparinized saline solution and perfused with latex. The results show that circulation was present but signifincatly reduced in the one-hour group, slightly reduced in the six-hour and 24-hour groups, and normal in the one- and two-week groups. This study indicates that the collateral circulation of the tongue is extensive and that a normal vascular pattern returns within a week after unilateral ligation of the common carotid artery.

Animals↗

Preliminary results of Tc-99m ECD SPECT to evaluate cerebral collateral circulation during balloon test occlusion.

PURPOSE: The authors obtained noninvasive quantitative measurements of regional cerebral blood flow using Tc-99m L,L-ethyl cysteinate dimer (Tc-99m ECD) SPECT to evaluate cerebral collateral circulation during balloon test occlusion (BTO) of the internal carotid artery and vertebral artery (VA). METHODS: Five cases associated with an aneurysm and a brain tumor were investigated. After 10 minutes of BTO, a bolus of Tc-99m ECD was injected intravenously and radionuclide angiography was performed. The balloon remained inflated for an additional 5 minutes. After radionuclide angiography was completed, brain SPECT imaging was performed. For quantitative analysis, regions of interest were defined on the transverse images on each side of the anterior cerebral artery and middle cerebral artery territories in cases of occlusion of the internal carotid artery. Regions of interest were defined for the posterior cerebral artery territory and cerebellum in cases of occlusion of the VA. The percentage activity change during BTO was calculated. RESULTS: In two of the three patients in whom BTO of the internal carotid artery was performed, the percentage activity reduction of more than 30% was noted in the anterior cerebral and middle cerebral artery territories. These two patients underwent bypass grafting before carotid occlusion. In one of the two patients in whom BTO of the VA was performed, the percentage activity reduction of 16% was noted in the posterior cerebral artery territory. This patient underwent bypass grafting before occlusion of the VA. CONCLUSION: This noninvasive and quantitative method of cerebral blood flow measurement using Tc-99m ECD during BTO appears to have the potential to help select patients who may tolerate temporary or permanent arterial occlusion.

Balloon Occlusion↗

Functional significance of alpha-adrenergic receptors in mature coronary collateral circulation of dogs.

There is little information on the functional significance of alpha-adrenergic receptors in the dog's coronary collateral circulation. Accordingly, we investigated the effects of infusion of either norepinephrine (NE) or B-HT 920 (BHT), an alpha 2-adrenergic agonist, on vascular resistance of coronary collaterals in chloralose-anesthetized dogs 2-3 mo after placement of an Ameroid constrictor around the left circumflex coronary (LCX) artery. To accomplish this, the vagotomized left ventricle was autoperfused through the left main coronary ostium using a servo-controlled constant-pressure pump. Pressures of the left anterior descending (LAD) and peripheral LCX arteries were measured, and regional blood flow in LAD and LCX regions were determined with radioactive microspheres before and during NE infusion in the unblocked condition, following beta-adrenergic and beta + alpha 1-adrenergic blockade with the use of propranolol and prazosin, respectively. The same parameters were also measured before and during BHT infusion following beta-adrenergic and beta + alpha 2-adrenergic blockade with the use of propranolol and idazoxan, respectively. In the unblocked condition, NE reduced LAD, LCX, and collateral resistance by 43, 50, and 31%, respectively. After beta-adrenergic blockade, NE increased LAD resistance (29%) but did not alter LCX or collateral resistance. The increase in LAD resistance was abolished following alpha 1-adrenergic blockade. BHT increased vascular resistance in LAD, LCX, and collateral circulations by 35, 29, and 45%, respectively. Selective alpha 2-adrenergic blockade significantly attenuated the vasoconstrictor response to BHT.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Antagonists↗

Use of Tc-99m HMPAO brain SPECT to evaluate cerebral collateral circulation during Matas test.

Five patients with traumatic carotid-cavernous fistulae and two patients with internal carotid artery aneurysms inside the cavernous sinus are presented. A quantitative method was used for the evaluation of brain collateral circulation in the anterior and middle cerebral artery territories by using Tc-99m HMPAO SPECT before and during the Matas test. It affords a more reliable quantitative measurement of reduced activity than conventional carotid angiography during the Matas test. In this study, a reduction of radioactivity of less than 15% during the Matas test did not reveal any postoperative neurological deficit after a carotid artery trapping procedure. This noninvasive method seems to be useful to determine the appropriate surgical treatment.

Adult↗

[Are the spontaneous coronary recanalization and the coronary collateral circulation really important in the left ventricular preservation in acute myocardial infarct?].

PURPOSE: To determine if maintenance of residual blood flow to culprit coronary artery in acute myocardial infarction is important in preserving left ventricular systolic function. METHODS: Prospective study of 63 consecutive survivors of acute myocardial infarction in the prethrombolytic era that were submitted to cinecoronary angiography and 30 degrees RAO left ventriculography on the 4th week. Culprit coronary artery patency and collateral circulation were correlated with global and segmental left ventricular contractility. RESULTS: Spontaneous coronary recanalization correlated significantly with better left ventricular systolic function only in patients with anterior wall myocardial infarction. This relationship was stronger with segmental than with global contractility. Besides, it was seen that absence of recanalization of pre-septal left anterior descending coronary artery occlusion resulted in significantly worse global and segmental left ventricular systolic function than post-septal occlusion, resulting in left ventricular aneurysm in all patients (2/3 of recanalized patients versus 1/3 of post-septal occlusions). Collateral circulation to culprit coronary artery correlated significantly with better global and segmental left ventricular contractility only in patients with inferior wall myocardial infarction. CONCLUSION: In acute anterior wall myocardial infarction spontaneous coronary artery recanalization is associated with better global and segmental left ventricular systolic function, specially if the occlusion is of pre-septal localization, while collateral circulation is not related to better contractility. In acute inferior wall myocardial infarction one sees the reverse.

Adult↗

Temporal evolution of the human coronary collateral circulation after myocardial infarction.

An analysis of the coronary collateral circulation in a consecutive series of 116 postinfarction angiograms from patients with persistent 100% occlusion of their infarct artery is reported. Patients were classified into four groups according to the interval between acute infarction and angiography. Of 42 patients studied within 6 hours of infarction (Group I), 52% had no evidence of any coronary collateral development as compared with only 8% (1 of 16 patients) studied 1 day to 2 weeks after infarction (Group II). Virtually all patients studied beyond 2 weeks after myocardial infarction (14 to 45 days, Group III) and later than 45 days (Group IV) had visible collateral flow. Angiographically "well developed" collateral channels were seen in only 16% of Group I patients compared with 62, 75 and 84% of patients in Groups II to IV, respectively. Of six patients studied twice, on the day of the infarction and 2 weeks later, only one patient had collateral vessels on the day of infarction, whereas all six patients did at follow-up study. Group I patients were studied as part of a randomized acute myocardial infarction reperfusion trial, whereas the other patients were referred for angiography primarily because of post-infarction ischemia. Within the limitations imposed by the patient selection process, it is concluded that well developed coronary collateral vessels are rarely present at the time of infarction. After infarction, they develop rapidly and are generally demonstrable within 2 weeks. It may also be inferred that the preservation of ischemic myocardium by well developed coronary collateral vessels at the time of myocardial infarction may be an uncommon occurrence.

Collateral Circulation↗

Myocardial ischemia during percutaneous transluminal coronary angioplasty in patients with rich collateral circulation of the target lesion.

Although it is commonly believed that ischemia does not develop during coronary intervention in patients with rich collateral circulation to the target vessel, ST changes are often observed, the study group comprised 40 consecutive patients who underwent elective percutaneous coronary angioplasty and who had rich collateral vessels to the target lesions. None had side branches in the target vessel that would be occluded by the angioplasty balloon. During the intervention, the 12-lead electrocardiogram was monitored for any change in the ST-T segment and 13 (32.5%) showed significant ST changes. Of these, 3 had ST changes with every balloon inflation and the remaining 10 patients had ST changes with the second or subsequent inflations. Myocardial ischemia caused by balloon inflation is not uncommon during coronary angioplasty in patients with rich collaterals to the target vessel. The collateral circulation may stop functioning very early after improvement in the forward flow of the target vessel.

Angina Pectoris↗

Evaluation of brain collateral circulation by the transcranial color Doppler-guided Matas' test.

For the determination of the indication for reconstruction of the carotid artery in patients with head and neck cancer, a color Doppler-guided Matas' test was performed to examine brain collateral circulation and blood flow of the middle cerebral artery (MCA) and internal carotid artery (ICA). Both SSA-270A convex (3.75 MHz) and linear (3.75 MHz and 2.5 MHz) array probes (Toshiba Co, Ltd) were used for this investigation. A temporary occlusion test (60 seconds) by digital pressure on the common carotid artery was performed on 30 patients with head and neck cancer. The results were classified into four groups according to the relative flow volume (percent blood flow volume before the test) of the MCA: group A, with a flow volume of 87% or more; group B, with a flow volume between 72% and 86%; group C, with a flow volume between 57% and 71%; and group D, with a flow volume of 56% or less. The relative flow volume of the MCA was correlated with the ICA stump pressure and single photon emission computed tomography during a balloon Matas' test (ICA occlusion). This test seems to be useful in predicting the risk of carotid resection without reconstruction and in determining the indication for reconstruction of the carotid artery.

Adult↗

Significance of collateral circulation in reversible left ventricular asynergy by nitroglycerin in patients with relatively recent myocardial infarction.

To evaluate the functional role of coronary collateral circulation in reversible asynergy of the left ventricle, cineventriculography was performed before and after the administration of sublingual nitroglycerin in 19 patients with complete occlusion of the proximal part of the left anterior descending coronary artery. In nine patients who had significant collateral circulation to the infarct-related coronary artery (group A), there was significant improvement in both the left ventricular ejection fraction (53% to 60%, p less than 0.05) and regional wall motion in the infarct zone (8% to 18%, p less than 0.01 in the anterolateral area) with administration of nitroglycerin. In contrast, in the remaining 10 patients without significant collateral perfusion (group B), there were no detectable changes in either global function (49% versus 50%) or regional wall motion (6% versus 8% in the anterolateral area) before and after nitroglycerin. Changes in heart rate and left ventricular peak systolic and end-diastolic pressures with nitroglycerin were comparable in both groups. These results suggest that angiographically demonstrable collaterals preserve viable myocardium, which can improve its contraction when the supply-demand relationship is favorably affected because of increased collateral flow and/or more favorable loading conditions produced by nitroglycerin.

Cineradiography↗