- Bio-technologies for a glandular stem cell cardiomyopexy. [Journal Article]
- AAAnn Anat 2009; 191(1):45-50
- The glandular stem cell cardiomyopexy should become a treatment option for end-stage heart failure. It combines an expected regenerative potential of transformed adult glandular stem cells into cardi…
The glandular stem cell cardiomyopexy should become a treatment option for end-stage heart failure. It combines an expected regenerative potential of transformed adult glandular stem cells into cardiomyocytes within the myocardium or onto the myocardium of the recipient and the potential of a hypercapillarized latissimus dorsi muscle (LDM) wrapped around the heart for stem cell nutrition and girdling.
- Neovascularization in the human heart is associated with expression of VEGF-A and its receptors Flt-1 (VEGFR-1) and KDR (VEGFR-2). Results from cardiomyopexy in ischemic cardiomyopathy. [Journal Article]
- AAngiogenesis 1999; 3(4):345-51
- Cardiomyopexy is a novel means of revascularization in end-stage ischemic heart disease leading to neovascularization and increased perfusion of the damaged heart. So far, the mediators of this proce…
Cardiomyopexy is a novel means of revascularization in end-stage ischemic heart disease leading to neovascularization and increased perfusion of the damaged heart. So far, the mediators of this process have not yet been identified. However, among others, vascular endothelial growth factor-A (VEGF-A) is a strong candidate for inducing this process. We have performed cardiomyopexy in humans by transplanting a flap of the musculus latissimus dorsi onto the epicardium. One of the patients died 7 weeks after cardiomyopexy due to a septic process unrelated to the underlying cardiac disease. Tissue specimen from the transplanted muscle flap, from the myocardium and from the native musculus latissimus dorsi were analysed by histological and immunohistochemical methods. The transplanted muscle appeared severely degenerated and showed no immunoreactivity for von Willebrandt factor (vWF) and for VEGF-A nor for its receptors KDR and Flt-1. However, a granulation zone had developed next to the transplanted muscle enriched with monocytes and macrophages which is characterized by a network of capillaries reaching into the ischemic myocardium and providing evidence for strong induction of angiogenesis. This process is accompanied by the abundance of VEGF-A expression in the endothelial layer of vessels. In parallel, VEGF-receptor KDR is present in capillaries passing into the subepicardial region supporting the idea of VEGF-A-induced angiogenesis. The spatial expression pattern of VEGF-A and KDR suggests VEGF-A to be a promotor of angiogenesis leading to indirect myocardial revascularization.
- [Cardiomyopexy--current status of an indirect revascularization method]. [Review]
- ZKZ Kardiol 1997; 86 Suppl 1:125-32
- From May 1993 to September 1995, six patients underwent a new myocardial revascularization procedure. These patients were not suitable for direct coronary artery surgery due to diffuse and peripheral…
From May 1993 to September 1995, six patients underwent a new myocardial revascularization procedure. These patients were not suitable for direct coronary artery surgery due to diffuse and peripheral coronary stenosis and severe angina pectoris (NYHA classes III-IV). Thus, indirect myocardial revascularization or cardiomyopexy was performed. This consists in the grafting of a free skeletal muscle flap onto the ischemic heart. After harvesting the musculus latissimus dorsi as a free flap, the graft was transplanted onto the heart. The arterial stump of the muscle flap artery was implanted directly into the aorta, venous flow was drained into the right atrium. There to four weeks after the intervention the patients were free from angina. Ischemic ST-segment changes appearing preoperatively at 50 W disappeared 8 weeks later even at a higher exercise tolerance. The two patients that underwent the intervention in 1993 and 1994 are still free from angina. In the present work experimental and clinical experiences with indirect myocardial revascularization are summarized and discussed.
- Paced skeletal muscle for dynamic cardiomyoplasty. [Case Reports]
- ATAnn Thorac Surg 1988; 45(6):614-9
- Four patients, each with a history of myocardial infarction and diffuse coronary artery disease, underwent application of left latissimus dorsi (LD) muscle with intact neurovascular bundle to the ant…
Four patients, each with a history of myocardial infarction and diffuse coronary artery disease, underwent application of left latissimus dorsi (LD) muscle with intact neurovascular bundle to the anterolateral wall of the left ventricle. The muscle was conditioned over a six-week period subsequent to operation in 3 patients and was conditioned preoperatively with a burst stimulus in the fourth. Biopsy specimens confirm the experimental data that human skeletal muscle can be electrically conditioned over a six- to ten-week period to contain mainly fatigue-resistant type I fibers. All patients survived the procedure, and 3 showed improvement secondary to aneurysmectomy. In Patient 1, a modified resection was performed, and at 28 months after operation, at the 75-W level of exercise, the ejection fraction was 54% paced versus 45% nonpaced. In Patient 2, at 12 months, the ejection fraction at rest was 44% paced versus 30% nonpaced. Doppler echo studies confirmed the presence of the flap and its function in the paced and nonpaced mode. The third patient died of a sudden ventricular arrhythmia 2 months following operation. An infected, nonfunctioning, degenerated flap was found at autopsy. Patient 4 did not have an aneurysm. She received a bypass graft to the right coronary artery and underwent cardiomyopexy in an attempt to relieve medically refractory incapacitating chronic congestive heart failure. Ten months postoperatively, ejection fraction at rest was 33% paced versus 25% nonpaced. Constrictive myopathy has not been encountered in any of these patients.
- [Experiences with aneurysmorrhaphy & cardiomyopexy for postinfarction changes in the myocardium]. [Journal Article]
- CLCas Lek Cesk 1957 Dec 13; 96(50):1537-43