Myoangiogenesis after cell patch cardiomyoplasty and omentopexy in a patient with ischemic cardiomyopathy.
We describe a procedure to promote angiogenesis and impregnation of skeletal myoblast into infarcted myocardium. At the completion of coronary artery bypass surgery, the midline sternotomy incision was extended to open the abdomen, and the greater omentum was tailored to reach the myocardium. Four pieces of autologous rectus muscle were applied to the infarcted left ventricle. This implantation was reinforced by the greater omentum. Incisions were closed in the usual manner. Postoperatively, the patient showed significant improvements in left ventricular ejection fraction (from 0.15 to 0.40) and in exercise tolerance (from 3 METs to 6 METs, or 100%). Computed tomographic angiography and positron emission tomography demonstrated improved myocardial viability and vascularity in the ischemic segments of the left ventricle. Omentopexy and cell patch cardiomyoplasty in conjunction with coronary artery bypass surgery may stimulate myogenesis and angiogenesis in avascular, dyskinetic scar tissue of left ventricle; in this preliminary study, this procedure appeared to improve the functional capacity of the left ventricle.
Taheri
Syde A
SA
Department of Cardiothoracic Surgery, University of Buffalo and Kaleida Health Systems, Buffalo, New York, USA. Staheri268@aol.com
Ashraf
Hasmat
H
Merhige
Michael
M
Miletich
Robert S
RS
Satchidanand
Sateesh
S
Malik
Chetan
C
Naughton
John
J
Zhao
Qiang
Q
D018421:Cardiomyoplasty / Q000379:methods*; D017023:Coronary Angiography; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D009206:Myocardium / Q000648:ultrastructure; D018919:Neovascularization, Physiologic; D009852:Omentum / Q000637:transplantation*; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed; D016277:Ventricular Function, Left