Thorsten Reffelmann, Robert A Kloner

Figure 2.1 Anatomical no-reflow, visualised in a rabbit model of coronary occlusion and reperfusion. Monastral blue (A) and thioflavin S (B, photography under ultraviolet light, Minolta Y48 barrier filter) were injected into the left atrium after 120 minutes of coronary artery occlusion and 120 minutes of reperfusion. Both dyes leave a substantial part of the left ventricle unstained, indicating areas of no or low perfusion. A close look at the slices demonstrates that (although closely correlating) the area not stained by monastral blue is slightly larger than the non-fluorescent area, reflecting the ability of the two dyes to penetrate into areas of hypoperfusion.

subsarcolemmal blebs of neighbouring swollen myocytes.1 Ultrastructural investigations after different durations (20180 minutes) of occlusion in a dog model of coronary ligation and reperfusion demonstrated that microvascular damage (first observed after 60 minutes of occlusion) always lagged behind myocardial cell injury (first apparent after 20 minutes of ischaemia) and that microvascular alterations were always located in zones of irreversibly damaged myocytes.2 Areas not stained by the fluorescent dye were characterised by low regional myocardial blood flow (mean (SEM) 0.13 (0.03) ml/ g/min to 0.26 (0.04) ml/g/min), as assessed by radioactive microspheres.3

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