What’s New in Salvage of the Ischemic Myocardium: Estrogen Postconditioning

Murry et al. [1] , devised the promising technique of preconditioning to salvage the myocardium from perfusion’s subsequent ischemic insult. This technique is used for repetitive brief episodes of ischemia before the occurrence of prolonged major ischemia that becomes lethal. While the technique is very promising as a new method of treatment for ischemic heart disease, its application in clinical practice has been arduous and highly risky. The difficulty is caused by a lack of the means to determine the time of occurrence of ischemia. Nevertheless, the technique can be applied in open heart surgery. At this level, repetitive inflating and deflating of the angioplasty balloon is easy to apply with almost no damage to the occluded blood vessel and can offer salvage from subsequent prolonged ischemia. Sometime later, Vinten-Johansen and his coworkers [2] introduced a technique similar to preconditioning with a greater probability of application to actual clinical practice. Postconditioning, the newly introduced technique, is the application of brief, repetitive ischemia and reperfusion. However, the innovation is that the procedure is performed after the ischemic insult and immediately at the beginning of reperfusion. This technique was found to be very efficient in providing protection to the ischemic myocardium and easily applied in clinical practice. An Early Intervention in the Treatment of Ischemic Heart Disease