Growth and Remodeling: Coronary Veins and Therapeutic Implications

Although there is significant literature on the effect of pressure overload on the structural and mechanical remodeling of coronary arteries as described in Chap. 3 , studies on the remodeling of veins in response to pressure overload are less abundant. In the case of coronary veins, understanding venous arterialization in response to pressure overload (e.g., in venous ligation) is vital for such therapeutic approaches as coronary retroperfusion. Indeed, studies have shown that prior venous ligation reduces the mortality rate from subsequent coronary ligation. This is consistent with the well-known clinical observation that patients with right heart failure, and hence elevated coronary sinus pressure, are less prone to anginal pain.