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(Circulation. 1997;95:1357-1359.)
© 1997 American Heart Association, Inc.

Articles

Transmural Channels as a Source of Blood Flow to Ischemic Myocardium?

Insights From the Reptilian Heart

Peter Whittaker, PhD; Robert A. Kloner, MD, PhD

The Heart Institute, Good Samaritan Hospital, and the Department of Medicine, Section of Cardiology, University of Southern California, Los Angeles.

Key Words: Editorials • myocardium • vasculature • lasers • blood flow

	Introduction

 
Kohmoto et al¹ have demonstrated, using several different techniques, that alligator hearts receive a significant amount of blood perfusion from the "inside out." That is, in addition to blood flow through the coronary arteries, blood flows directly into the myocardial tissue from the ventricular cavity. Such a circulation is possible because the inner two thirds of the alligator left ventricle is composed of tissue with a "spongelike" appearance. This tissue contains numerous trabecular spaces or "sinusoids" that have direct connections with the ventricular cavity. Similar architectural features have also been reported in fish hearts.² The advantage of such a myocardial structure is that a significant degree of myocardial viability might be maintained even if the coronary arteries were completely occluded by atherosclerosis.

	De-Evolving the Human Heart: The Premise for Transmyocardial Revascularization

 
Why should the readership of Circulation have any interest in the coronary anatomy of alligators or fish? Although to the best of our knowledge these creatures do not require bypass surgery or angioplasty because of advanced coronary artery disease, humans do. Not all patients, however, are suitable candidates for these revascularization procedures, so in the quest for alternative therapies,³ efforts have been made to surgically mimic the reptilian circulation and exploit the concept that other conduits in addition to coronary arteries might be created to provide blood flow to the heart. Specifically, several groups have suggested that by making numerous channels through the myocardium (transmyocardial revascularization [TMR]), it might be possible to "de-evolve" mammalian hearts, restore a reptilian pattern of perfusion, and hence bypass diseased coronary vessels.^{4 5}

In . . . [Full Text of this Article]

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