title: [Usefulness of intracoronary therapy with progenitor cells in patients with dilated cardiomyopathy: Bridge or alternative to heart transplantation?].
abstract: OBJECTIVE
  Some paediatric publications have recently raised the value of intracoronary therapy with autologous bone marrow-derived progenitor cells (APCs) in children with dilated cardiomyopathy (DCM) and heart failure. We describe the usefulness of this treatment in two infants with severe DCM and heart failure, who had been transferred to our hospital for cardiac transplant evaluation.
  
  
  METHODS
  The first patient was a 3 months old male weighing 4 kg. The second was a 4 months old male weighing 5 kg. At the time of admission, both were in poor clinical condition (NYHA IV), with severe dilation and systolic dysfunction (ejection fraction [EF]<30%) of the left ventricle and marked elevation of NT-proBNP, requiring treatment with mechanical ventilation and inotropic iv infusion. After mobilization with G-CSF for 4 days, APCs were obtained from peripheral blood by leukocytapheresis, administering them by a slow intracoronary bolus injection using a stop-flow technique (6.15x106 CD34-positive cells/Kg in the first patient, and 10.55x106 CD34-positive cells/Kg in the second).
  
  
  RESULTS
  Since the first week after the procedure, clinical status of patients improved and echocardiography showed a decrease in left ventricular dilation. A month later, there was a significant improvement in EF (> 40%) and NT-proBNP levels, subsequently maintained throughout the follow-up. However, four months later in the first patient, the left ventricle dilated again and its function slightly worsened, but without any significant impact in his clinical status.
  
  
  CONCLUSIONS
  Intracoronary therapy with APCs can be an alternative in children, especially infants, with DCM and heart failure. It can reduce the waiting list mortality, improve clinical status and provide more time on the waiting list to receive a suitable organ, or even to make transplantation unnecessary.
authors.affiliation: Servicio de Cardiología Infantil, Hospital Universitario La Paz, Madrid, España. jrivas.hulp@salud.madrid.org
authors.forename: J
authors.initials: J
authors.lastname: Rivas
authors.forename: J J
authors.initials: JJ
authors.lastname: Menéndez
authors.forename: R
authors.initials: R
authors.lastname: Arrieta
authors.forename: J
authors.initials: J
authors.lastname: Alves
authors.forename: M P
authors.initials: MP
authors.lastname: Romero
authors.forename: L
authors.initials: L
authors.lastname: García-Guereta
authors.forename: R
authors.initials: R
authors.lastname: Álvarez-Doforno
authors.forename: M
authors.initials: M
authors.lastname: Parrón
authors.forename: A
authors.initials: A
authors.lastname: González
authors.forename: F
authors.initials: F
authors.lastname: Ruza
authors.forename: F
authors.initials: F
authors.lastname: Gutiérrez-Larraya
mesh_terms: D002311:Cardiomyopathy, Dilated / Q000601:surgery*; D003331:Coronary Vessels; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D008297:Male; D012720:Severity of Illness Index; D033581:Stem Cell Transplantation / Q000379:methods