Piek J J, Becker A E
Department of Pathology, Academic Medical Center, Amsterdam-Zuidoost, The Netherlands.
J Am Coll Cardiol. 1988 Jun;11(6):1290-6. doi: 10.1016/0735-1097(88)90294-x.
The relation between the type and size of myocardial infarcts and collateral development was studied in postmortem human hearts with a new approach that allows quantification of vascular beds. The coronary arteries were perfused with radioactive microspheres and were visualized by injecting a barium-gelatin mixture. The collateral supply was assessed in 6 reference hearts without infarction, 4 hearts with a transmural infarct and 12 hearts with a total of 16 subendocardial infarcts. The distribution pattern of microspheres in hearts in the reference group did not differ significantly from that in hearts with a transmural infarct but was significantly different (p less than 0.01) from that in hearts with a subendocardial infarct, which had a much greater number of microspheres in the collateral-dependent area. Moreover, the lateral zone of myocardium at risk--defined as the area containing viable myocardium but within the distribution zone of the occluded artery--was small in hearts with a transmural infarct (less than or equal to 2 mm), but showed a much wider range in hearts with a subendocardial infarct. This study strongly suggests that collateral vessels play an important role during the development of myocardial infarction, both in determining infarct type (transmural versus subendocardial) and in preserving the viability of the lateral zone of the myocardium at risk.
采用一种可对血管床进行量化的新方法，对人死后心脏中心肌梗死的类型、大小与侧支循环发育之间的关系进行了研究。向冠状动脉灌注放射性微球，并通过注入钡 - 明胶混合物使其显影。评估了6个无梗死的对照心脏、4个透壁性梗死心脏以及12个共有16个心内膜下梗死的心脏的侧支供血情况。微球在对照组心脏中的分布模式与透壁性梗死心脏中的分布模式无显著差异，但与心内膜下梗死心脏中的分布模式显著不同（p小于0.01），在心内膜下梗死心脏的侧支依赖区域中微球数量更多。此外，有透壁性梗死的心脏中，定义为包含存活心肌但在闭塞动脉分布区域内的心肌危险侧区较小（小于或等于2毫米），而在心内膜下梗死的心脏中则范围大得多。这项研究有力地表明，侧支血管在心肌梗死的发展过程中起着重要作用，既决定梗死类型（透壁性与心内膜下），又保护危险心肌侧区的存活能力。
