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.

[1]  M. Komeda,et al.  Transplanted Skeletal Myoblasts Can Fully Replace the Infarcted Myocardium When They Survive in the Host in Large Numbers , 2003, Circulation.

[2]  Matthias Loebe,et al.  New surgical therapies for heart failure , 2003, Current opinion in cardiology.

[3]  A. Hagège,et al.  Autologous skeletal myoblast transplantation for severe postinfarction left ventricular dysfunction. , 2003, Journal of the American College of Cardiology.

[4]  R. Dawar,et al.  Primary malignant fibrous histiocytoma of the greater omentum. , 2002, Tropical gastroenterology : official journal of the Digestive Diseases Foundation.

[5]  R. Califf,et al.  Comparison of coronary artery bypass grafting versus medical therapy on long-term outcome in patients with ischemic cardiomyopathy (a 25-year experience from the Duke Cardiovascular Disease Databank). , 2002, The American journal of cardiology.

[6]  P. McCarthy.  Synergistic approaches in the surgical treatment of heart failure: complex solutions for complex problems. , 2002, Seminars in thoracic and cardiovascular surgery.

[7]  A. Hagège,et al.  Myoblast transplantation for heart failure , 2001, The Lancet.

[8]  D. O’Leary,et al.  Use of the greater omentum in colorectal surgery , 1999, Diseases of the colon and rectum.

[9]  D. Sax,et al.  Omental transposition for cerebral infarction: a 13-year follow-up study. , 1999, Surgical neurology.

[10]  R. Hetzer,et al.  Decision-making in end-stage coronary artery disease: revascularization or heart transplantation? , 1997, The Annals of thoracic surgery.