Surgical revascularization of hibernating myocardium: the known and the unknown

Background Recovery of function is possible in patients with ischemic cardiomyopathy when left ventricular dysfunction is caused by stunning or hibernation. It is plausible that recovery of function after revascularization may take a longer time in hibernating myocardium compared with stunned myocardium. Accordingly, the time courses of functional recovery in hibernating and stunned myocardium were compared. Methods and Results Patients (n=26) with ischemic cardiomyopathy undergoing surgical revascularization were studied; regional perfusion (resting 201 Tl single-photon emission CT), glucose utilization ( 18 F-2-deoxyglucose single-photon emission CT), and contractile function (2D echocardiography) were assessed before revascularization. Dysfunctional segments with normal perfusion/glucose utilization were considered to be stunned, and dysfunctional segments with reduced perfusion/preserved glucose utilization were considered to be hibernating. Contractile function was reevaluated 3 months (early) and 14 months (late) after revascularization. Of the 266 dysfunctional segments, 57 (22%) were stunned, 62 (23%) were hibernating, and 147 (55%) were scar tissue. In stunned myocardium, contractile function improved significantly at 3 months, without further improvement at 14 months; 61% of the stunned segments improved at 3 months, and 9% improved at 14 months. In hibernating myocardium, contractile function improved at 3 months, with a further improvement at 14 months; 31% of the hibernating segments improved at 3 months, and 61% showed (additional) recovery at 14 months. Conclusions Stunned myocardium is likely to demonstrate early recovery of function, whereas hibernating myocardium may take a longer time to (fully) recover in function after revascularization.

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Delayed recovery of hibernating myocardium after surgical revascularization: Implications for discrepancy between metabolic imaging and dobutamine echocardiography for assessment of myocardial viability

Journal of Nuclear Cardiology ◽

10.1016/s1071-3581(99)90109-5 ◽

1999 ◽

Vol 6 (6) ◽

pp. 685-687 ◽

Cited By ~ 9

Author(s):

J BAX

Keyword(s):

Myocardial Viability ◽

Metabolic Imaging ◽

Hibernating Myocardium ◽

Surgical Revascularization ◽

Dobutamine Echocardiography ◽

Delayed Recovery

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Very distal vein bypass in patients with thromboangiitis obliterans

VASA ◽

10.1024/0301-1526/a000624 ◽

2017 ◽

Vol 46 (4) ◽

pp. 304-309 ◽

Cited By ~ 4

Author(s):

Achim Neufang ◽

Carolina Vargas-Gomez ◽

Patrick Ewald ◽

Nicolaos Vitolianos ◽

Tolga Coskun ◽

...

Keyword(s):

Conservative Treatment ◽

Vein Graft ◽

Duplex Ultrasound ◽

Critical Limb Ischaemia ◽

Thromboangiitis Obliterans ◽

Surgical Revascularization ◽

Autologous Vein ◽

Therapeutic Concept ◽

Autologous Vein Graft ◽

Vein Bypass

Abstract. Background: Surgical revascularization for chronic critical limb ischaemia in patients with thromboangiitis obliterans (TAO) still remains controversial. Generally, besides cessation of smoking, conservative treatment supported by intravenous administration of vasoactive agents is regarded as the treatment of choice, in combination with local wound therapy or minor amputation. Patients and methods: In four male patients (42-47 years) surgical revascularization was chosen as therapy for established gangrene or non-healing ulceration after unsuccessful conservative treatment and cessation of smoking. Angiography was able to identify a suitable distal arterial segment for the bypass which was revascularized by means of an autologous vein graft. Grafts were followed with repetitive duplex ultrasound. Revision of the bypass graft was initiated if indicated by pathological duplex findings. Results: In all cases a bypass could be constructed with either the ipsilateral greater saphenous vein or arm veins. A distal origin configuration was possible in three cases with popliteo-pedal or cruro-pedal bypasses. In the fourth case the distal superficial femoral artery was used for inflow. Two early graft thromboses underwent successful revision. During follow-up, duplex ultrasound identified graft stenoses in three bypasses which were successfully treated with endovascular techniques. All grafts are patent with complete resolution of ischaemic symptoms after 46, 42, 32, and 29 months. The patients remained non-smokers and returned to a professional life. Conclusions: Surgical therapy with distal vein bypass for persistent ischaemic symptoms after definitive cessation of smoking seems feasible in selected cases with TAO and a suitable distal artery. Close follow-ups of the patients with duplex ultrasound are necessary to identify developing vein graft stenoses. Angioplasty seems to be an important part of the long-term therapeutic concept.

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