A Novel Hypothetical Method to increase the Dimensions of the Coronary Arteries when Required

Mark Christopher Arokiaraj


Background: The purpose was to develop a novel hypothetical method to increase the size of coronary arteries.

Methods: During long-term observation an increase in coronary size has been seen in three unexpected scenarios. Changes in coronary artery sizes were observed in patients with mitral stenosis (n=69) by angiogram prior to percutaneous balloon mitral valvuloplasty or valve replacement surgery for severe mitral stenosis. The coronaries of patients with patent ductus arteriosus who underwent surgical closure in the past (n=14) were examined by echocardiogram. Patients with renal failure on long-term dialysis through peripheral arterio-venous fistula without left ventricular hypertrophy (n=17) were studied by echocardiography. Normal age, weight and sex matched coronary sizes served as controls in the study. All these observations were made over a period of 12 years.

Results: The sizes of coronaries in patients with mitral stenosis, patients who underwent closure for patent ductus arteriosus, and in patients on hemodialysis through arteriovenous fistulas were higher than normal controls (p<0.05, for all). A hypothetical model to increase the coronary sizes could be developed based on the analysis of the differential equations of Poiseuille’s. A method is proposed of creating a peripheral arterio-venous fistula, which could be closed later electively by a percutaneous method/surgery. The closure time needs to be determined by experimental studies. The other methods could be a continuous exercise program or by the use of beta-blockers.

Conclusion: A novel hypothetical method of peripheral arteriovenous fistula formation is decsribed which could potentially increase the size of the coronaries, which could be closed later.


Coronary dimensions, Poiseuille’s Equation, Arteriovenous fistula, Coronary dilatation, Wall shear stress, Coronary blood flow, Atherosclerosis, Angiogenesis

Full Text:



Cheng K, de Silva R. New advances in the management of refractory angina pectoris. Eur Cardiol. 2018;13(1):70–79. doi:10.15420/ecr.2018:1:2.

Manchanda A, Aggrawal A, Aggrawal N, et al. Management of refractory angina pectoris. Cardiol J. 2011;18(4):343-51.

Ertan C, Ozeke O, Gul M, et al. Association of prediabetes with diffuse coronary narrowing and small-vessel disease. Journal of Cardiology. 2014; 63: 29–34. doi: 10.1016/j.jjcc.2013.06

Nelson RH. Hyperlipidemia as a Risk Factor for Cardiovascular Disease. Primary care. 2013;40(1):195-211. doi:10.1016/j.pop.2012.11.003.

Cheng C, Helderman F, Tempel D et al. Large variations in absolute wall shear stress levels within one species and between species. Atherosclerosis. 2007;195(2):225-235. doi: 10.1016/j.atherosclerosis.2006.11.019

Columb M, Atkinson M. Statistical analysis: sample size and power estimations. BJA Education. 2016;16(5):159-161. doi:10.1093/bjaed/mkv034

Sutera, Salvatore P.; Skalak, Richard. The History of Poiseuille’s Law. Annual Review of Fluid Mechanics. 1993; 25: 1–19.

Osman Bektaş, Zeki Yüksel Günaydın, Ahmet Karagöz, et al. Effects of Mitral Balloon Valvuloplasty on Coronary Blood Flow and Flow Reserve. The Journal of Heart Valve Disease 2015;24:729-735.

Mymin D, Sharma G. Total and effective coronary blood flow in coronary and noncoronary heart disease. Journal of Clinical Investigation. 1974;53(2):363-373. doi: 10.1172/JCI107568

Kincaid K, Ward M, Nair U, et al. The Coronary Baroreflex in Humans. The Journal of Extra-corporeal Technology. 2005;37(3):306-310.

Uruno A, Sugawara A, Kanatsuka H, et al. Hepatocyte Growth Factor Stimulates Nitric Oxide Production through Endothelial Nitric Oxide Synthase Activation by the Phosphoinositide 3-Kinase/Akt Pathway and Possibly by Mitogen-Activated Protein Kinase Kinase in Vascular Endothelial Cells. Hypertension Research. 2004;27(11):887-895. DOI:10.1291/hypres.27.887

Morishita R, Aoki M, Yo Y, et al. Hepatocyte Growth Factor as Cardiovascular Hormone: Role of HGF in the Pathogenesis of Cardiovascular Disease. Endocrine Journal. 2002;49(3):273-284. doi: 10.1507/endocrj.49.273

Lönn J, Starkhammar Johansson C, Kälvegren H, et al. Hepatocyte growth factor in patients with coronary artery disease and its relation to periodontal condition. Results in Immunology. 2012;2:7-12. doi: 10.1016/j.rinim.2011.12.002

Marinou K, Christodoulides C, Antoniades C, et al. Wnt signaling in cardiovascular physiology. Trends in Endocrinology & Metabolism. 2012;23(12):628-636. doi:10.1016/j.tem.2012.06.001

Reis M, Liebner S. Wnt signaling in the vasculature. Experimental Cell Research. 2013;319(9):1317-1323. doi: 10.1016/j.yexcr.2012.12.023.

Meyer IS, Jungmann A, Dieterich C, et al. The cardiac microenvironment uses non‐canonical WNT signaling to activate monocytes after myocardial infarction. EMBO Molecular Medicine. 2017;9(9):1279-1293. doi:10.15252/emmm.201707565.

Mazzotta S, Neves C, Bonner R, et al. Distinctive Roles of Canonical and Noncanonical Wnt Signaling in Human Embryonic Cardiomyocyte Development. Stem Cell Reports. 2016; (7): 764–776. doi:10.1016/j.stemcr.2016.08.008

McElhinny A, Li J, Wu L. Mastermind-like transcriptional co-activators: emerging roles in regulating cross talk among multiple signaling pathways. Oncogene. 2008;27(38):5138-5147. doi:10.1038/onc.2008.228

Anderson L, Gibbons G. Notch: a mastermind of vascular morphogenesis. Journal of Clinical Investigation. 2007;117(2):299-302. doi:10.1172/JCI31288.

Lee SW, Moskowitz MA, Sims JR. Sonic hedgehog inversely regulates the expression of angiopoietin-1 and angiopoietin-2 in fibroblasts. International Journal of Molecular Medicine. 19 (3); 445–51: 2007. doi.org/10.3892/ijmm.19.3.445

Golper T, Hartle P, Bian A. Arteriovenous fistula creation may slow estimated glomerular filtration rate trajectory. Nephrology Dialysis Transplantation. 2015;30(12):2014-2018. doi:10.1093/ndt/gfv082

Soran O, Kennard E, Kfoury A, et al. Two-Year Clinical Outcomes After Enhanced External Counterpulsation (EECP) Therapy in Patients With Refractory Angina Pectoris and Left Ventricular Dysfunction (Report from the International EECP Patient Registry). The American Journal of Cardiology. 2006;97(1):17-20. doi:10.1016/j.amjcard.2005.07.122

Sharma U, Ramsey HK, Tak T. The Role of Enhanced External Counter Pulsation Therapy in Clinical Practice. Clinical Medicine & Research. 2013;11(4):226-232. doi:10.3121/cmr.2013.1169.

V. Kitsou, T. Xanthos, R. Roberts, et al. Enhanced external counterpulsation: mechanisms of action and clinical applications. Acta Cardiologica. 2010;65(2):239-247. doi: 10.2143/AC.65.2.2047060

Einstein A. 1946, “An Elementary Derivation of the Equivalence of Mass and Energy,” in A. Einstein(1956), pp. 116–119.

Palacios A. The Mass-Energy Equivalence Principle in Fluid Dynamics. Journal of High Energy Physics, Gravitation and Cosmology. 2015;01(01):48-54.

doi: 10.4236/jhepgc.2015.11005.

Šorli, A.S. Mass–Energy Equivalence Extension onto a Superfluid Quantum Vacuum. Sci Rep 9, 11737 (2019) doi:10.1038/s41598-019-48018-2.

Ronai C, Hamaoka-Okamoto A, Baker A, de Ferranti S, Colan S, Newburger J et al. Coronary Artery Aneurysm Measurement and Z Score Variability in Kawasaki Disease. Journal of the American Society of Echocardiography. 2016;29(2):150-157. doi:10.1016/j.echo.2015.08.013

Margossian R, Lu M, Minich LL, et al. Predictors of coronary artery visualization in Kawasaki disease. JAmSocEchocardiogr.2011;24(1):53–59. doi:10.1016/j.echo.2010.10.015.

Alla Boshchenko, Alexander Vrublevsky and Rostislav Karpov (September 15th 2011). Transthoracic Echocardiography in the Assessment of Coronary Arteries, Coronary Angiography - Advances in Noninvasive Imaging Approach for Evaluation of Coronary Artery Disease, Branislav Baskot, IntechOpen, doi: 10.5772/21793.

Said K, Hassan M, Baligh E, Zayed B, Sorour K. Ventricular Function in Patients with End-Stage Renal Disease Starting Dialysis Therapy: A Tissue Doppler Imaging Study. Echocardiography. 2012;29(9):1054-1059. doi:10.1111/j.1540-8175.2012.01749.x

Alkhouli M, Sandhu P, Boobes K, Hatahet K, Raza F, Boobes Y. Cardiac complications of arteriovenous fistulas in patients with end-stage renal disease. Nefrología (English Edition). 2015;35(3):234-245. doi:10.1016/j.nefro.2015.03.001

Reddy Y, Obokata M, Dean P, Melenovsky V, Nath K, Borlaug B. Long-term cardiovascular changes following creation of arteriovenous fistula in patients with end stage renal disease. European Heart Journal. 2017;38(24):1913-1923. doi:10.1093/eurheartj/ehx045

Shewan LG, Coats AJS, Henein MY. Authors’ Responsibilities and Ethical

Publishing. International Cardiovascular Forum Journal 2018;13:3-4, DOI:


DOI: https://doi.org/10.17987/icfj.v19i0.671

Copyright (c) 2020 The author

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.