A closed-loop system for pressure-controlled intermittent coronary sinus occlusion

Computer-based instrumentation of a closed-loop system for pressure-controlled intermittent coronary sinus occlusion (PICSO) is described. PICSO is a procedure for treatment of ischemic myocardium via the venous side of the coronary circulation. The coronary venous outflow is intermittently obstructed with a balloon-tip catheter positioned in the coronary sinus, with the object of washing out toxic metabolites and redistributing the blood flow in the myocardium. Because of the relatively large capacitance in the coronary venous system, a PICSO occlusion-release cycle usually lasts for several cardiac cycles to achieve a significant pressure perturbation in the coronary sinus. The PICSO cycle should be adapted to the physiologic state of the heart. The closed-loop system described monitors the coronary sinus occlusion pressure and predicts the appropriate occlusion-release timing. The system should be useful for optimizing PICSO in animal studies as well as in clinical trials.