The physiologic and histologic properties of the distal internal thoracic artery and its subdivisions Gideon Sahar, MD, Reut Shavit, MD, Zohar Yosibash,

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Presentation transcript:

The physiologic and histologic properties of the distal internal thoracic artery and its subdivisions Gideon Sahar, MD, Reut Shavit, MD, Zohar Yosibash, DSc, Lena Novack, PhD, Menachem Matsa, MD, Benjamin Medalion, MD, Edith Hochhauser, PhD, Dan Aravot, MD The Journal of Thoracic and Cardiovascular Surgery Volume 149, Issue 4, Pages 1042-1050 (April 2015) DOI: 10.1016/j.jtcvs.2014.12.028 Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Experimental protocol. A, Experimental system. B, Length-tension curve. X-axis represents the micrometer displacement. Y-axis represents the wall tension in gram force. C, Experimental protocol timeline. D, Progressive steps in the creation of a length-tension curve. E, Arterial contraction in response to the addition of NE. NE, Norepinephrine. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 1042-1050DOI: (10.1016/j.jtcvs.2014.12.028) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Histopathologic analysis. A and B, Measurement of intimal hyperplasia indices, hematoxylin–eosin ×4. A, Intimal thickness index. B, Intimal to medial ratio. C and D, Quantitative analysis of muscle content in the media. C, SE, SMA stain, ×4. D, Same specimen at ×20 magnification. Red = muscle. Yellow = extracellular matrix. E and F, Typical morphologies of intimal hyperplasia, hematoxylin–eosin stain, ×4 magnification. E, SE artery showing significant intimal thickening with narrowing of the arterial lumen. F, MP artery showing concentric intimal hyperplasia. G and H, Positive SMA stain in the intimal hyperplastic areas. G, ITA, hematoxylin–eosin stain, ×10. H, Same specimen SMA stain, ×20. I and J, Elastic fibers stain. I, MP, ×10. Arrow, Internal and external elastic laminae. J, SE, ×10. Defects and doubling areas in the internal elastic lamina are observed. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 1042-1050DOI: (10.1016/j.jtcvs.2014.12.028) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Anatomy and flow. A, Contribution of subdivisions to ITA length. B, Comparison of length parameters between genders. C, Free flow in ITA and subdivisions. D, Comparison of free flow rates between genders. ITA, Internal thoracic artery; MP, musculophrenic; NS, not significant; SE, superior epigastric. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 1042-1050DOI: (10.1016/j.jtcvs.2014.12.028) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Dose-response relationships for NE. A, Dose-response curve for NE. The relation is presented for the ITA, SE, and MP arteries based on a least mean square estimate of 1/p and EC50 (3 curves), and the experimental results (bars). B, Contraction and sensitivity to NE in different arterial segments determined by least mean square from experiments. The higher contractility in ITA subdivisions, suggesting caution in the use of the bifurcation for revascularization, is demonstrated. However, the extra length, sufficient flow, and favorable histologic properties suggest that the bifurcation may be appropriate for coronary revascularization in selected cases. ITA, Internal thoracic artery; LMS, least mean square; MP, musculophrenic; NE, norepinephrine; SE, superior epigastric; SEM, standard error of the mean; EC50, effective concentration that induces 50% of the maximal contraction force. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 1042-1050DOI: (10.1016/j.jtcvs.2014.12.028) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions