[Anesthetic management of therapeutic angiogenesis with autologous bone marrow cells for medically intractable angina pectoris].
We report anesthetic management of therapeutic angiogenesis with autologous marrow cells for medically intractable angina pectoris. A 64-year-old man suffering from severe angina after multiple bypass surgery was presented for this novel procedure. Under general anesthesia with propofol, about 650 ml of bone marrow was aspirated from his ilium in prone position. Hypotension was treated with volume infusion and the use of vasoactive drugs. Next, left thoracotomy was performed with the patient in right lateral position. With the aid of one lung ventilation, the apex and the posterior wall of the heart, where ischemia had been localized, was exposed. An epicardial stabilizer was used to immobilize the apex where purified marrow cells were manually injected. Ventricular premature beats occurred when marrow cells were injected, but they were self-limited. The procedure was completed without any serious complications. Prevention of perioperative myocardial ischemia, volume supplementation during bone marrow aspiration and preparation for ventricular arrhythmia during injection were suggested to be the key issues in the management of this procedure.
Kimoto
Michiyo
M
Department of Anesthesiology, Kansai Medical University, Moriguchi 570-8507.
Sato
Norihito
N
Yamazaki
Etsuko
E
Shirane
Atsuko
A
Shingu
Koh
K
D000758:Anesthesia / Q000379:methods*; D000787:Angina Pectoris / Q000628:therapy*; D016026:Bone Marrow Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D018919:Neovascularization, Physiologic; D012008:Recurrence; D014182:Transplantation, Autologous