[In vivo analysis of the morphofunctional state of myocardial blood supply in ischemic heart disease].

The patency of coronary arteries and morphofunctional features of myocardial microhemocirculation were studied in 40 males with coronary heart disease (CHD) aged 36-59 using intravital coronary angiography, intraoperative left ventricular biopsies assessed electron-microscopically and by semithin sections. In spite of various impairment of the coronary arteries, there was similar clinical presentation. It was found that in addition to atherosclerosis stenosing the main subepicardial vessels in CHD, there appeared a peripheral barrier for the tissue circulation with defective permeability of the myocardial microvessels. Intramyocardial vascular disorders were characterized by noticeable changes in blood rheology, reactivity of resistive vessels and angiosclerosis. The role of multifactor endothelial deformities rose significantly as well as of extravasal compression of the microvessels in interstitial edema and sclerosis, in affected cardiomyocytes. Moreover, the permeability of the histohematic barrier came to be destroyed. The above changes can be considered as reversible, irreversible and amenable to correction. The findings led the investigators to the conclusion on a role of the dysfunction of the intramyo cardial vascular bed as an essential mechanism of CHD pathogenesis responsible for realization of the functional factors.