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J Thorac Cardiovasc Surg 2008;136:1131-1135
© 2008 The American Association for Thoracic Surgery

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The legacy of coronary sinus interventions: Endogenous cardioprotection and regeneration beyond stem cell research

^a Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
^b Department of Biomedical Engineering, Austrian Research Centers, Wiener Neustadt, Austria

Received for publication March 3, 2008; revisions received April 18, 2008; accepted for publication May 15, 2008.

^_* Address for reprints: Werner Mohl, MD, PhD, Department of Cardiothoracic Surgery, University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria. (Email: werner.mohl@meduniwien.ac.at).

The first 300 words of the full text of this article appear below.

	Introduction

 

Even when laws have been written down, they ought not always to remain unaltered.

—Aristotle, Politics

Greek critic, philosopher, physicist, and zoologist (384 BC–322 BC)

	The Road to Reality

 
Gaining new ground in scientific comprehension needs to radically overrule current beliefs reversing constraints of popular science genre with a unique combination of respect for the complexity of nature, the achievements of the past, and striving toward the final goal to fight disease.

The coronary sinus, as minimally invasive access to the diseased heart, is an attractive route occupying generations of researchers. As in many other scientific developments and achievements in biology and medicine, coronary sinus interventions lack uniformity and leave observers with plenty of uncertainty. Facts and myths are scattered, leaving ground for speculations and piling up constraints for the future. These constraints include the potential to recapitulate old mistakes or ill-fated avenues but also leave room to bridge to new ideas on a sound basis of new understanding of mistaken and unappreciated information.

The recent reports on the development of a coronary sinus reducer stent for the treatment of chronic refractory angina pectoris have focused new interest on the concept of coronary sinus interventions necessitating a second look at widely established knowledge and a redirection of a potential "fausse route" jeopardizing scientific targets. Permanent elevation of right-sided pressures in the heart is known to occur during the development of cardiac failure. Our clinical predecessors knew that patients had a lucid interval with improvement of symptoms as soon as right atrial pressure transmitted into the cardiac venous system, a phenomenon that is known also from the Fontan circulation.¹

Although this improvement does not last very long but rather deteriorates promptly, it is certainly the basis for treatment options like the coronary reducer stent.

	The Past and the Present of Coronary Sinus Interventions

 
The coronary sinus has been a surgical domain from its . . . [Full Text of this Article]