Cardiovascular applications of fluorocarbons in regional ischemia/reperfusion

Potential cardiovascular therapeutic uses for perfluorochemicals include oxygen delivery distal to an occluding balloon during high risk coronary angioplasties, treatment for acute myocardial infarction with or without concomitant reperfusion, cardioplegia, and preservation of donor hearts for transplant. Infusions of oxygenated perfluorochemicals during brief coronary occlusions, as occurs with angioplasties, preserves cardiac ultrastructure and cardiac function. Fluosol is currently approved in the U.S. for angioplasty procedures. Experimental studies have suggested that perfluorochemicals reduce myocardial infarct size during permanent coronary occlusion or temporary coronary occlusion. One school of thought suggests that these agents work by reducing reperfusion injury. By inhibiting neutrophil function, including adherence to endothelial cells and release of toxic substances, perfluorochemicals may preserve the endothelium and prevent no-reflow. However, one might argue that any agent which reduces infarct size by any mechanism would result in less neutrophil infiltration and smaller no-reflow areas. One pilot study suggested that intracoronary Fluosol administered at the time of reperfusion, reduced infarct size and improved regional ventricular function in patients. However, preliminary results of a large multicenter study in which this agent was given along with thrombolysis, were largely negative. Whether perfluorochemicals will become an important adjunctive agent along with reperfusion for acute myocardial infarction remains to be determined.