The sober explanation for this book is a call by the Springer-Verlag, London, to edit a publication on ‘The functional relevance of the collateral circulation’ of the heart. Alternatively, it could be ‘sold’ as the result of my intention to reduce entropy of 18 years of scientific work on the topic of the coronary circulation, which was itself meant to diminish the amount of ‘useless’ energy. Such a process of reducing disarray in a system with the aim of grasping it better is related to simplification, which carries the risk of introducing error. This can be exemplified by the historic view of angina pectoris, which used to be simplified as being always fatal, thus obscuring for nearly two centuries the view of a ‘self-healing’ mechanism such as the collateral circulation of the heart. It would be na?¨ve, to assume the present work to be free of erroneous oversimplification, because the very nature of scientific work is related to generating (simple) hypotheses with their subsequent falsification. In that context and bluntly, my primary interest in the field of the collateral circulation was not initiated with a vision of eradicating the consequences of coronary artery disease (CAD) by promoting the growth of natural bypasses. The time for such sizeable ideas had passed in the 1970s with the start of the work by Wolfgang Schaper.
Practical review of the collateral circulation
Extensive scientific review of the physiology
Specific to human coronary vessel information
Cardiovascular diseases are the leading cause of death in industrialized countries. Established options for revascularization include angioplasty and surgical bypass, both of which are unsuitable in 20–30% of patients in whom the extent of coronary atherosclerosis is especially severe. An alternative treatment strategy for revascularization is therefore warranted both to control symptoms as well as to alter the course of advanced coronary artery disease. An ideal candidate to fill in this gap is therapeutic promotion of coronary collateral growth, that is, the induction of natural anastomoses of ischemic areas. In order to reach this goal, a comprehensive understanding of the human coronary collateral circulation with regard to its relevance, accurate assessment, the pathogenetic and pathophysiological aspects, and the different therapeutic options is mandatory.
Collateral Circulation of the Heart focuses on the practical aspects of human coronary collateral vessels. It includes explanation of the basic science and pathophysiological aspects, as the clinical aspects cannot be fully understood without a thorough grounding in the physiology of the formation of collaterals. Professor Seiler, an international expert on the subject, has written this authoritative reference to provide a comprehensive review of the topic, its impact and clinical relevance. Suitable for all cardiologists, cardiovascular radiologists, internal medicine and critical care physicians, students of cardiovascular medicine and human physiologists, the book contains many stunning illustrations that give a flavor of the huge variability in collateral vessel formation, including all the relevant imaging modalities, and the possibilities of alleviating ischemic symptoms in many patients.
Relevance of the Human Coronary Collateral Circulation – (Historical aspects, Intersprecies comparisons, Prognostic relevance).Assessment of the Human Coronary Collateral Circulation – (Walking-through or warm-up angina pectoris, Non-invasive characterization, The coronary occlusion model, Invasive methods for qualitative and quantitative assessment). Pathogenesis of the Human Coronary Collateral Circulation - (Clinical factors influencing the development of collaterals, Genetic aspects of formation) Pre-formation of collaterals in patients with coronary artery disease and normal individuals). Functional aspects or pathophysiology of the Human Coronary Collateral Circulation - (Tolerance of the myocardium to ischemia and the role of collaterals, The acute response of collateral flow to different stimuli such as physical exercise, Handgrip exercise, cold pressor, vasoactive drugs, The phenomenon of coronary collateral steal, The interaction between collateral flow and intraventricular pressure) 'Therapeutic promotion of the Human Coronary Collateral Circulation' – (Angiogenesis and arteriogenesis, Cytokines, proteases, growth factors, Stem cells, Physical exercise, Passive external counterpulsation)