Terapia de células-tronco no infarto agudo do miocárdio, através de perfusão coronariana retrógrada: uma nova técnica

Abstract

352Based on these observations, the hemodynamics team initiated the treatment of myocardial infarction with injection of bone marrow stem cells in a retrograde way through the coronary sinus. Case ReportThe patient is a 63-year-old, obese man with diabetes, hypertension, dyslipemia, and a positive familial history of coronary artery disease and previous myocardial infarction in the inferior wall 4 years earlier. Twelve days previously, the patient had an acute myocardial infarction in the anterior wall, which evolved for 14 hours. The patient underwent angioplasty and successful stent implantation but began to complain of fatigue on mild effort and nocturnal paroxysmal dyspnea.The electrocardiogram showed third-degree left bundle-branch block. The echocardiogram showed cavitary enlargement, anterior and inferior akinesia, and an ejection fraction of 24%. Thallium-201 myocardial scintigraphy showed anterior and inferior fibrosis. The cardiac catheterization evidenced a significantly enlarged ventricle due to anterior and inferior akinesis, and apical dyskinesis. On angiography, the ejection fraction was 25%, and the left ventricular Pd2 was 34 mmHg. The right coronary artery showed a diffuse lesion in its proximal segment and distal occlusion. The left main coronary artery had no obstruction, the circumflex artery had parietal irregularities and occluded marginal branches, and was opacified through the homocollaterals. The anterior descending artery was diffusely damaged from the junction of the middle and distal segments onwards. The first medium-caliber diagonal branch had a severe lesion in its origin.Taking all this into consideration, the patient and his family were presented with the possibility of retrograde bone-marrow stem cell injection through the anterior descending vein to cause myogenesis and angiogenesis. The patient agreed with the procedure proposed, as did the committee on ethics subordinate to the Argentinean government and Health Ministry.With the patient under general anesthesia, puncture of the iliac crest and bone marrow aspiration were performed.The upper layer (leukocyte concentrate containing mononuclear cells) was separated from the erythrocytes by centrifugation, and the latter were reinfused into the patient. Then the leukocytic Adult stem cells removed from the bone marrow have been used for the treatment of ischemia and acute myocardial infarction, improving ventricular function and/or myocardial perfusion and/or reducing the size of the infarction 1-4 . We present a new technique for retrograde stem cell infusion in the coronary sinus for the treatment of acute myocardial infarction used for the first time in human beings.Stem cells have been infused according to the 2 following routes: 1) anterograde intracoronary infusion, about which Giordano 5 reported that the endothelium of the coronary microcirculation is continuous, constituting a barrier to the passage of macromolecules to the myocardium; that author also reported that another area of possible resistance is the vascular se...

Padrão de distribuição de células mononucleares de medula óssea em tecido cardíaco sadio por diferentes vias de infusão

“…A via intramiocárdica de entrega de células em tecido cardíaco pode ser utilizada nos casos em que o emprego da via intracoronária é inadequado; no entanto, em decorrência de sua habilidade de entregar as células de modo seletivo nas regiões normais e peri-infartadas, eventos como extrassístoles e arritmia ventricular podem ser observados 13 . Recentemente, foi aventado o emprego da via retrógrada venosa como uma possível via de entrega de células 14 cães com peso aproximado de 25 kg (3 animais por grupo). Para a inclusão dos animais foram realizados exames bioquímicos séricos para alanina aminotransferase, creatina quinase fração MB (CK-MB), creatinina, hemograma, eletrocardiografia e ecocardiografia.…”

Cell therapy in congestive heart failure

“…The intracoronary venous route, the retrograde coronary perfusion, is another important delivery method for stem cell therapy (Giordano, 2003;Murad-Netto et al, 2004). The coronary venous system was cannulated with a novel, investigational, double-balloon catheter.…”

Injeção intracoronariana de células tronco após infarto do miocárdio: subestudo da microcirculação

“…This is particularly important because Janssens et al 5 found that half of patients undergoing autologous stem-cell transplant after AMI showed a microvascular obstruction pattern at the cardiac MRI, which may have impaired the migration of cells to cardiac tissue and hence, heart function improvement. Little is known about the retrograde percutaneous approach through the coronary vein, although this route has shown to be an effective way to deliver cells in animal human and models [6][7][8] . We suppose that the intravenous coronary (IVC) delivery can overcome the problem of MVO, because the diapedesis of circulating cells in the adjacent cardiac tissue occurs in the venous…”