de Oliveira Sérgio Almeida, Gowdak Luís Henrique W, Buckberg Gerald, Krieger José Eduardo
Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
Eur J Cardiothorac Surg. 2006 Apr;29 Suppl 1:S259-65. doi: 10.1016/j.ejcts.2006.02.005. Epub 2006 Mar 27.
The concept of cell therapy as an adjunctive therapy to myocardial surgical revascularization for patients with severe coronary artery disease is illustrated by two case reports of ischemic cardiac disease that were unsuitable for revascularization by coronary grafting. The potential interaction of cell therapy, magnetic resonance imaging (MRI) of viability, and left ventricle (LV) restoration is described.
Each patient had an ejection fraction below 30%, a relatively conical heart, and MRI gadolinium scan showing predominantly viable muscle.
Intramyocardial injections of autologous bone marrow-derived cells (BMC) were performed along with either incomplete coronary artery bypass grafting (CABG) (to mother regions) or with transmyocardial laser revascularization (TMLR). An improvement in contractile function was seen at 6-12-month intervals after the procedure.
The implications of possible underlying mechanisms of improvement in both myocardial perfusion and contractility suggest the striking importance of both micro- and macroenvironment for any cell-based therapeutic strategy. These observations imply that the interaction of cell biology, viability by MRI and geometry may be important in the future, as geometry can be restored surgically, and the new architectural form may develop enhanced function if it contains viable tissue and cell-based treatment can be delivered.
通过两例不适合冠状动脉搭桥血运重建的缺血性心脏病病例报告，阐述细胞治疗作为重症冠状动脉疾病患者心肌外科血运重建辅助治疗的概念。描述了细胞治疗、存活心肌磁共振成像（MRI）和左心室（LV）恢复之间的潜在相互作用。
每位患者的射血分数均低于30%，心脏相对呈圆锥形，MRI钆扫描显示主要为存活心肌。
在不完全冠状动脉旁路移植术（CABG）（至主要区域）或经心肌激光血运重建术（TMLR）的同时，进行心肌内自体骨髓来源细胞（BMC）注射。术后6至12个月期间，观察到收缩功能有所改善。
心肌灌注和收缩力改善的潜在机制的意义表明，微观和宏观环境对于任何基于细胞的治疗策略都极为重要。这些观察结果表明，细胞生物学、MRI显示的存活能力和心脏几何形状之间的相互作用在未来可能很重要，因为心脏几何形状可通过手术恢复，如果包含存活组织且能进行基于细胞的治疗，新的结构形式可能会发展出增强的功能。
