Zusammenfassung. Grundlagen: Die Regeneration von avitalem Myokard durch Zellimplantation gewinnt zunehmend an wissenschaftlichem Interesse.Methodik: Myoblasten, mesenchymale und embryonale Stammzellen und andere Vorläuferzellen werden derzeit in verschiedenen experimentellen Settings untersucht. Ein Überblick über den Status quo wird dargestellt.Ergebnisse: Etwa 200 Patienten wurden mit verschiedenen Techniken behandelt. Derzeit können nur vorläufige Ergebnisse aufgezeigt werden.Schlussfolgerungen: Die Idee, die Regeneration von geschädigtem Myokard durch Zellimplantation herbeizuführen, ist faszinierend. Verschiedenste Zelltypen werden in unterschiedlichen experimentellen Settings angewandt. Die zelluläre Kardiomyoplastie scheint die Größe und den Fibrosegehalt in postischämischen Narben zu reduzieren. Wie sich diese Therapiemöglichkeit entwickeln wird, kann derzeit noch nicht abgeschätzt werden Schlüsselwörter: zelluläre Kardiomyoplastie, Herzinsuffizienz, Stammzellen.Summary. Background: Cell-based regenerative therapy is undergoing different experimental and clinical trials in order to limit the consequences of decreased contractile function and compliance of damaged ventricles following myocardial infarction.Methods: An overview of the actual status quo. Results: Over 200 patients have been treated worldwide with cell-based procedures for myocardial regeneration. Results are preliminary.Conclusions: Cellular cardiomyoplasty seems to reduce the size and fibrosis of infarct scars, limit postischemic remodelling, and restore regional myocardial contractility.
Os autores apresentam uma série de 15 pacientes submetidos a cirurgia cardíaca cuja proteção miocárdica foi obtida por infusão de solução cardioplégica sangüínea isotérmica por via retrógrada atrial. As operações consistiram em 11 revascularizações do miocárdio e 4 cirurgias orovalvares. Após instalação da circulação extracorpórea, iniciou-se a infusão da solução cardioplégica de indução na porção inicial da aorta, exceto nos casos de insuficiência aórtica. A solução de indução foi infundida por cinco minutos, passando-se, então, à solução de manutenção. No início da infusão da solução de manutenção, através de cateter de 4,0 mm no átrio direito, as veias cavas e o tronco pulmonar foram pinçados e passou-se a aspirar a aorta. Todos os pacientes saíram de circulação extracorpórea sem qualquer dificuldade ou suporte inotrópico. Não houve registro de infarto agudo do miocárdio. Dois pacientes com fibrilação atrial apresentaram ritmo sinusal já no centro cirúrgico.
This study presents the results in a group of fifteen patients submitted to cardiac surgery, using continuous atrial retrograde warm blood cardioplegia for myocardial protection. Eleven patients were submitted to myocardial revascularization and four were submitted to valvular transplantation. There was no need for inotropic drugs or intraaortic balloon pump support during or after the procedure, and no myocardial infarction was detected in this group. When the heart was arrested, the cardioplegia line was switched to the atrial cannula. The aortic root was vented throughout the cross-clamp period, and retrograde perfusion was assured by noting the engorged exygenated cardiac veins as well as the return of dark blood through the vent in the aortic root. The patients presented good clinical and laboratory course. No right ventricular dysfunction was detected. Two patients were in atrial fibrillation before the surgery, one of them returned to this cardiac rhythm three days after the procedure
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