Effect of echocardiography-guided percutaneous intramyocardial septal radiofrequency ablation on the Lown classification in patients with hypertrophic obstructive cardiomyopathy / 中华超声影像学杂志

Objective:To investigate the effect of percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) guided by echocardiography on the Lown classification of ventricular arrhythmias in patients with hypertrophic obstructive cardiomyopathy (HOCM).Methods:A total of 85 patients with HOCM who received PIMSRA treatment at Xijing Hospital of Air Force Military Medical University from May 2017 to October 2019 were retrospectively selected. All patients underwent 24-hour Holter examinations before and 1 year after PIMSRA to obtain parameters related to Lown classification. The changes in Lown grades after PIMSRA were analyzed. The patients were divided into improved group and unimproved group according to whether there was significant improvement in Lowen′s grades, and the difference of the parameters related were compared. The influencing factors of the changes in Lown classification were analyzed.Results:Compared with before PIMSRA, there was a significant improvement in the Lown classification after PIMSRA ( P=0.001). The patients with Lown grade Ⅰ increased significantly ( P=0.001), and the patients with grade Ⅲ decreased significantly ( P=0.005). There were no significant changes in patients with Lown grades 0, Ⅱ, and Ⅳ (all P>0.05). The proportion of patients with family history of hypertrophic cardiomyopathy (HCM), the baseline Lown classes, the reduction rate of the maximum left ventricular wall thickness and the reduction rate of the provocative left ventricular outflow tract gradient (LVOTG) were higher in the improved group than the unimproved group (all P<0.05). Multivariate Logistic regression results showed that HCM family history ( OR=3.95, 95% CI=1.34-11.64, P=0.013), baseline Lown classes ( OR=2.01, 95% CI=1.25-3.22, P=0.004) and the reduction rate of the provocative LVOTG gradient ( OR=1.02, 95% CI=1.00-1.04, P=0.041) were independent factors of postoperative Lown classification improvement. Conclusions:The Lown classes of HOCM patients after PIMSRA is significantly improved.HCM family history, the baseline Lown classes, and the reduction rate of postoperative provocative LVOTG are independent influencing factors for the improvement of Lown grade.

A follow-up study of percutaneous intramyocardial septal radiofrequency ablation in the treatment of obstructive hypertrophic cardiomyopathy with mild septal hypertrophy / 中华超声影像学杂志

Objective:To evaluate the clinical efficacy of percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) in the treatment of obstructive hypertrophic cardiomyopathy (HOCM) with mild septal hypertrophy.Methods:Forty-five HOCM patients with mild septal hypertrophy (the maximal left ventricular wall thickness is 15-19 mm) who were treated with PIMSRA between November 2016 to February 2021 in the Hypertrophic Cardiomyopathy Center of Xijing Hospital of Air Force Military Medical University were enrolled, and their clinical datas were collected and analyzed. The clinical symptoms and NYHA functional class before operation, 6 months and 1 year after operation were collected. Interventricular septum thickness, left ventricular outflow tract pressure gradient, left ventricular outflow tract diameter, mitral regurgitation, left ventricular systolic and diastolic function were evaluated by transthoracic echocardiography before operation, 6 months and 1 year after operation, intraoperative complications were monitored and recorded. Postoperative arrhythmias were monitored by routine 12 lead ECG and 24-hour ambulatory ECG.Results:All patients successfully completed PIMSRA procedure.No clinical adverse events such as death, bleeding and stroke occurred during and around the operation.No left bundle branch block, complete atrioventricular block and malignant arrhythmia occurred after the operation. All patients did not need permanent pacemaker implantation.NYHA functional class and clinical symptoms of patients were significantly improved after 6 months compared with values before operation (all P<0.001, respectively), it remained stable for 1 year after operation; Anterior interventricular septum, posterior interventricular septum, maximal left ventricular wall thickness all significantly decreased (all P<0.001, respectively), left ventricular outflow tract diameter widened ( P<0.001), continuous improvement 1 year after operation; left ventricular outflow tract gradient and provoked left ventricular outflow tract gradient all significantly decreased, mitral regurgitation decreased and SAM classification reduced after 6 months compared with values before operation (all P<0.001, respectively); left ventricular end-diastolic diameter widened and left atrial diameter decreased (all P<0.001, respectively), it remained stable for 1 year after operation. Left atrial volume index decreased ( P<0.001), with continuous improvement 1 year after operation; The ratio of early diastolic mitral valve velocity to early diastolic mitral annulus velocity (E/e′) decreased ( P=0.001), it remained stable for 1 year after operation. There were no significant differences in left ventricular end diastolic volume, left ventricular end systolic volume and left ventricular ejection fraction among the three groups (all P>0.05). Conclusions:PIMSRA is effective in the treatment of obstructive hypertrophic cardiomyopathy with mild ventricular septal hypertrophy.

Rare Case of Sars COV2 Virus (COVID 19) Associated Intra Myocardial Hematoma and Role of Diagnostic Imaging

SARS Cov2 infection is a pandemic declared by WHO in early month of 2020 as corona virus disease (COVID 19) which was diagnosed first in Wuhan, China in December 2019. During first wave of COVID 19 we faced with severe acute respiratory insufficiency and respiratory failure with common symptoms of high-grade fever, shortness of breath and loss of sensations but later on we accessed the different symptoms to related with multi systems of human body. Cardiac emergencies or cardiovascular morbidities with mortality were accessed across the globe during COVID 19 pandemic era. Data revealed that SARS Cov2 affected on heart by both direct or indirect pathway which leads to acute myocarditis, myocardial injury/infarct, heart failure, thrombosis and arrhythmias. Here we are presenting a rare case as hematoma in myocardium called as intramyocardial dissecting hematoma. Non-invasive diagnostic tools to prevent mortality in cardiology field and avoid further complication.

Safety and efficacy of trans-right-ventricular echocardiography guided percutaneous intramyocardial septal radiofrequency ablation for interventricular septal reduction: an ovine model with 1-year outcomes / 中华超声影像学杂志

Objective:To investigate the safety and efficacy of echocardiography-guided trans-right-ventricular percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) in a healthy sheep model, and to observe the pathological changes of myocardium in ablation area one year later.Methods:Twelve sheep were divided into PIMSRA group ( n=6) and sham group ( n=6). In PIMSRA group, a radiofrequency (RF) electrode was inserted to the interventricular septum (IVS) with maximum power of 80 Watts for 5 minutes. In the sham group, RF electrode tip was positioned in IVS segment but without the RF power delivery. Electrocardiogram (ECG), echocardiography, myocardial contrast echocardiography(MCE) were performed to assess the efficacy of PIMSRA at postoperative immediately, 2-week, 1-month, 2-month, 3-month, 6-month and 12-month during the follow-up. The following parameters were recorded, including the thickness of ablation area, the systolic wall thickening rate and amplitude of movement of the ablated region, left ventricular outflow tract pressure gradient (LVOT PG), and left ventricular ejection fraction (LVEF), mitral valve early diastolic peak velocity(E), late diastolic peak velocity(A) and the E/A ratio, peak velocity of early diastolic mitral annular motion(E′), peak velocity of late diastolic mitral annular motion(A′), and the E′/A′ ratio.For both groups, the myocardial biomarkers of troponin I, myoglobin and isoenzymes of creatine kinase were tested before the ablation and 3 h after the ablation, and again after 2 weeks. Tissue pathology examinations were performed at the end of study. Results:None of the animals in both groups was observed to have pericardial tamponade during perioperative period.Immediately after the procedure, septal hypokinesis was seen in all PIMSRA group animals, the systolic wall thickening rate and amplitude of movement of the ablated region were significantly decreased ( P<0.001), which was sustained until 12 months.In Sham group, there were no significant differences in the wall thickening rate and amplitude of movement of the operated region(all P>0.05).The thickness of the ablation area in the PIMSRA group was significantly increased immediately after the procedure( P<0.001), decreased to baseline level at 1-week ( P=0.931), and significantly increased at 3-month ( P<0.001).In the Sham group, the IVS thickness was significantly increased immediately after the procedure( P=0.005), decreased to baseline level at 1-week ( P=0.027), then has no further significant changes.There were no significant differences in LVEF, E/A, E′/A′ between PIMSRA and Sham group(all P>0.05).MCE showed the thickness of the ablation area was significantly decreased in the PIMSRA group 12 months after the operation.In both groups, troponin I increased significantly 3 h after the operation(all P<0.005), which decreased to baseline level 2 weeks later(all P>0.05). ECG showed that all the sheep had normal sinus rhythm. Pathological examinations revealed the tissue in the ablation area was fibrotic, having clear boundary with the surrounding normal tissue and no carbonization was observed 1 year later. Conclusions:Echocardiography-guided trans-right-ventricular PIMSRA produced precisely ablated myocardial tissues, reduced the IVS thickness significantly, preserved the global left ventricular function. All the sheep had normal sinus rhythm and without pericardial tamponade in 1 year follow-ups. Echocardiography-guided trans-right-ventricular PIMSRA is a safe and effective minimally invasive treatment for septal reduction therapy.

Evaluation of myocardial microcirculation perfusion in patients with hypertrophic obstructive cardiomyopathy after Liwen procedure by myocardial contrast echocardiography / 中华超声影像学杂志

Objective:To quantitatively evaluate myocardial microcirculation perfusion changes after percutaneous intracardiac septal radiofrequency ablation (PIMSRA, Liwen procedure) in patients with obstructive hypertrophic cardiomyopathy (HOCM) using myocardial contrast echocardiography (MCE) and to further establish the effect of the procedure and predict the long-term prognosis of patients.Methods:A total of 45 patients with HOCM treated by the Liwen procedure in the First Affiliated Hospital of Air Force Medical University (Xijing Hospital) from July 2019 to June 2020 were included. MCE was performed before and 6 months after surgery, respectively. Time-intensity perfusion curve analysis was performed using QLab 10.8 offline software to obtain quantitative parameters of myocardial microcirculation perfusion including myocardial blood volume (A value), myocardial blood flow velocity (β value), and myocardial blood flow (A×β value), then the changes in parameters before and after the procedure were compared.Results:After the Liwen procedure, the mean septal thickness and mean left ventricular free wall thickness were significantly reduced, accompanied by a significant reduction in the left ventricular outflow tract pressure gradient (LVOT-PG) and mitral regurgitation length, and a significant improvement in mitral systolic antegrade motion (SAM) (all P<0.001). In addition, the left ventricular ejection fraction (LVEF) did not deteriorate significantly ( P=0.560) and the E/e′ ratio decreased after the procedure ( P=0.015). Besides, the A values of both the ventricular septum and the left ventricular free wall were not significantly changed compared to those before procedure ( P>0.05), whereas the β values and A×β values were obviously increased ( P<0.05). Conclusions:Myocardial blood velocity and myocardial blood flow in the septum and left ventricular free wall were significantly increased in patients with HOCM after the Liwen procedure, suggesting a significant improvement in myocardial microcirculation perfusion. MCE provides a non-invasive quantitative evaluation parameters of myocardial microcirculation perfusion for the Liwen procedure for the treatment of HOCM.

Puente miocárdico largo en la arteria descendente anterior como causa de síndrome coronario agudo / Long myocardial bridging in the left anterior descending artery causing acute coronary syndrome

RESUMEN Las arterias coronarias principales generalmente tienen un trayecto epicárdico. En algunos casos, pequeños segmentos de éstas se introducen en el interior del miocardio formando los denominados puentes miocárdicos. Esta particularidad anatómica puede producir un estrechamiento sistólico súbito del trayecto tunelizado (fenómeno de milking) y afectar el flujo coronario tanto en sístole como en diástole, con la consiguiente reducción de la reserva coronaria. Afecta principalmente a la arteria descendente anterior en sus segmentos medio y distal. Su presentación clínica puede ir desde un cuadro anginoso hasta la muerte súbita. Hasta el momento, parece ser, que el uso de betabloqueadores y anticálcicos es la opción terapéutica más efectiva en los casos sintomáticos. Se expone un caso en el que un síndrome coronario agudo fue la forma de presentación de esta variante anatómica y el oportuno diagnóstico angiográfico permitió realizar los reajustes terapéuticos necesarios para mejorar la sintomatología del paciente.

ABSTRACT Coronary arteries usually run along the outer surface of the heart. In some cases, small segments of them take a "tunneled" intramuscular course forming the so-called myocardial bridging. This anatomical feature may lead to a sudden systolic narrowing of the "tunneled" segment (milking effect), thereby impairing coronary blood flow in both systole and diastole; which further reduces coronary reserve. Myocardial bridging mainly affects the middle-distal segments of left anterior descending (LAD) artery and may cause anything from chest pain to sudden death. So far, it seems that the use of beta-blockers and anti-calcium agents is the most effective therapeutic option for symptomatic cases. We now report a case where the clinical presentation of this anatomical feature was an acute coronary syndrome. Timely, accurate angiographic diagnosis allowed for adequate therapeutic adjustments to improve the patient's symptomatology

Evaluation of effect of smoking on myocardial injury and prognosis in patients with acute ST-segment elevation myocardial infarction / 上海交通大学学报（医学版）

Objective • To investigate the influence of smoking on acute myocardial injury and long-term prognosis in the patients with ST-segment elevation myocardial infraction (STEMI) by cardiac magnetic resonance (CMR). Methods • Three hundred and forty-nine STEMI patients were retrospectively selected from a prospective cohort from May 2012 to August 2017, and were followed up for at least 2 years. The primary endpoint was a composite of all-cause death, reinfarction and stroke. The secondary endpoint was heart failure rehospitalization. The patients were divided into smoker group and non-smoker group according to the baseline status of smoking which was recorded at admission. The difference in the incidence of endpoint events was further analyzed in combination with the presence or absence of intramyocardial hemorrhage (IMH) between the two groups. Results • There were 221 patients in the smoker group, accounting for 63.3% of the total sample. The average age of onset in smokers were 4.66 years earlier than nonsmokers. However, smokers showed a lower incidence of left ventricular thrombosis and lower levels of brain natriuretic peptide than non-smokers (P=0.023, P=0.000). There was no difference in the left ventricular ejection fraction between the two groups (P>0.05), but the smokers had a better endsystolic and end-diastolic volume index (P=0.019, P=0.007). Smokers and non-smokers had similar clinical outcomes of all-cause death, reinfarction and stroke (P>0.05). The incidence of heart failure rehospitalization in smokers was quite lower than that of the non-smokers, but this kind of protective effect disappeared after differences in baseline being adjusted (P=0.167). In the patients with IMH, smoking had a protective effect on primary endpoints (HR=0.266, P=0.008), but in the patients without IMH, smokers had a worse outcome of all-cause death and reinfarction than non-smokers (P=0.024). Conclusion • In patients with STEMI, smoking has no protective effect on long-term prognosis. When IMH appears in STEMI patients, smoking has a protective effect on all-cause death, reinfarction and stoke. However, in patients without IMH, smokers have a worse prognosis than non-smokers.

Advances in intramyocardial hemorrhage of perfused acute myocardial infarction by cardiovascular magnetic resonance / 解放军医学杂志

The mortality of the patients with acute myocardial infarction (AMI) is greatly decreased by prompt revascularization. However, a substantial proportion of patients with AMI suffer from dysfunction of myocardial reperfusion, which affects long-term prognosis. Severe microvascular injury can cause intramyocardial hemorrhage (IMH), manifested as capillary endothelial cell connection damage and extravasation of erythrocytes. IMH further aggravates myocardial damage, enlarging myocardial infarct size, and provides incremental information to left ventricular remodeling and long-term major cardiovascular events. Cardiovascular magnetic resonance (CMR) can achieve in vivo evaluation of IMH, using the paramagnetic effects of iron containing metabolites produced by erythrocyte lysis. This review aims to introduce the advances in IMH by cardiovascular magnetic resonance.

Defecto septal postinfarto agudo de miocardio causado por hematoma disecante: A propósito de un caso

La ruptura del septum interventricular es reconocida como una complicación seria del infarto agudo de miocardio (IAM). Se han demostrado 2 tipos de ruptura cardíaca en el contexto de un IAM: simple y compleja, también llamada disección hemorrágica o hematoma disecante intramiocárdico. Se describe el caso de un paciente con IAM complicado con un gran defecto septal que comunica ambos ventrículos.

Rupture of the ventricular septum is a recognized serious complication of acute myocardial infarction (AMI). Two tipes of myocardial rupture have been previously described: simple and complex (hemorrhagic dissection or dissecting intramyocardial hematoma). This presentation reports the case of a patient with AMI complicated with a large ventricular septal defect in the inferior septum interventricular with communication between the right and left ventricles.

A ruptura do septo interventricular é reconhecida como uma complicação grave do infarto agudo do miocárdio (IAM). Dois tipos de ruptura cardíaca foram demonstrados no contexto de um IAM: Simples e complexo, também chamado de dissecção hemorrágica ou hematoma dissecante intramiocárdico. Descrevemos o caso de um paciente com IAM complicado por um grande defeito septal que comunica os dois ventrículos.

Perioperative management of intramyocardial hydatid cyst with off-pump technique

Cardiac echinococcosis is a rare disease. Depending on the location of hydatid cyst in the heart, clinical presentation can be an asymptomatic case or lethal stroke, arrhythmias, valvular dysfunction, cardiac tamponade, cardiac failure, shock, and even death. Treatment of choice for cardiac hydatid cysts is surgical excision, even in an asymptomatic patient. We present a case report of an asymptomatic case of off-pump removal of intramyocardial hydatid cyst. A 21-year-old male presented asymptomatically and was diagnosed with a hydatid cyst incidentally during a regular checkup. Echocardiography and cardiac computed tomography angiography images demonstrated an intramyocardial hydatid cyst on the lateral aspect of the left ventricle with slight extension over the anterior and posterior regions. Important aspects of diagnosis and management specific to cardiac hydatid cyst along with the review of literature have been discussed.

Cardiac MR detection of late microvascular obstruction and intramyocardial hemorrhage in predicting MACE in AMI after reperfusion therapy: Meta-analysis / 中国介入影像与治疗学

Objective To explore the predictive value of late microvascular obstruction (MVO) and intramyocaedial hemorrhage (IMH) detected with cardiac MR (CMR) for the major adverse cardiovascular events (MACE) in patients with myocardial infarction (AMI) after reperfusion therapy with Meta-analysis. Methods A systematic search was conducted in databases of PubMed, Embase, Web of Science, CNKI, VIP and Wanfang. The literature published before October 2018 were screened according to inclusion and exclusion criteria. Statistical analysis and quality evaluation were performed using RevMan 5.3 and STATA 15.1 software. Results A total of 11 articles were enrolled. Among them, 9 articles related to late MVO with a total of 1 872 patients, and 4 related to IMH with a total of 1 017 patients. Odd ratio (OR) of late MVO detected with CMR predicting MACE occurrence was 4.04 (95%CI [2.95, 5.55], Z=8.65, P<0.001), of IMH detected with CMR predicting MACE occurrence was 2.66 (95%CI [1.78, 3.96], Z=4.79, P<0.001). Conclusion The late MVO and IMH detected with CMR after AMI reperfusion therapy can be used to predict MACE during the follow-up.

Application of cardiac magnetic resonance imaging in acute ST-segment elevation myocardial infarction: Recent advances / 第二军医大学学报

Reperfusion therapy has significantly reduced the mortality of patients with acute ST-segment elevation myocardial infarction (STEMI), but the associated heart failure mortality is on a rise. It is important to seek novel cardioprotective therapies to improve clinical outcomes. Cardiac magnetic resonance (CMR) is an important imaging modality for assessing the efficacy of the novel therapies and the prognosis of the patients. T1 mapping and T2 mapping have provided new insights into the pathophysiology underlying myocardial edema, microvascular obstruction, intramyocardial hemorrhage, and the remote myocardial interstitial space after reperfused STEMI. This review sums up the recent advances on the application of the CMR in reperfused STEMI.

Intramyocardial dissecting hematoma of the right ventricle secondary to acute myocardial infarction. Case report / Hematoma intramiocárdico disecante del ventrículo derecho secundario a infarto agudo de miocardio. Reporte de caso

Abstract: Background: Intramyocardial dissecting haematoma is a rare form of cardiac rupture that can occur as a complication following acute myocardial infarction or during the remodelling process, with very scarce reports in medical literature. Usually caused by a haemorrhagic dissection among the spiral myocardial fibres. Case report: Here we report the case of a 60-year-old man with a previous infarction in the inferior wall extended to the right ventricle, in whom a dissecting intramyocardial haematoma in the free wall of the right ventricle was identified using transthoracic and contrast echocardiography, corroborated with cardiac magnetic resonance. Results: By this imaging modalities, it was possible to see the various acoustic densities of the progressive clotting of the hematoma, its extension through the haemorrhagic dissection, as well as its independency in relation to ventricular cavities and extracardiac space by confirming intact epicardial and endocardial layers. Conclusion: The patient presented a gradual improvement and hemodynamic stability, and basing on the existent medical literature, it was decided the medical treatment as the therapeutic option, maintaining asymptomatic after three months of follow-up.

Resumen: Antecedentes: El hematoma intramiocárdico disecante es una forma rara de ruptura cardiaca que puede ocurrir como una complicación posterior al infarto agudo de miocardio o durante el proceso de remodelación del mismo, con informes muy escasos en la literatura médica. Generalmente causada por una disección hemorrágica entre las fibras espirales del miocardio. Caso clínico: Se presenta el caso de un hombre de 60 años con infarto previo en la pared inferior extendido al ventrículo derecho, en el que se identificó un hematoma intramiocárdico disecante en la pared libre del ventrículo derecho mediante ecocardiografía transtorácica y contrastada, corroborado con resonancia magnética cardiaca. Resultados: Por medio de estas modalidades de imagen se pudieron observar las distintas densidades acústicas de la coagulación progresiva del hematoma, su extensión a través de la disección hemorrágica, así como su independencia en relación con las cavidades ventriculares y el espacio extracardiaco, confirmando las capas epicárdicas y endocárdicas indemnes. Conclusión: El paciente presentó una mejoría gradual y estabilidad hemodinámica, y basándose en la literatura médica existente, se decidió el tratamiento médico como opción terapéutica, manteniéndose asintomático después de tres meses de seguimiento.

Comparison of the efficiency of tail vein injection and intramyocardial injection of adenovirus vector in mice / 中国比较医学杂志

Objective To investigate the efficiency of target gene transfection of the heart and liver after tail vein or intramyocardial injection of adenovirus vector (GFP-Ad).Methods GFP-AD was constructed at first.A total of 20 male 8-week old C57BL/6 mice were randomly and equally divided into tail vein injection of GFP-AD group and intramyocardial injection of GFP-AD group.The mRNA levels of GFP in the heart and liver tissues were detected by Q-PCR at different time points.Fluorescence microscopy was performed to visualize the expression of GFP fluorescence.Results Compared with the tail vein injection group, the GFP mRNA level in mouse heart tissue was apparently higher in the intramyocardial injection group.In both groups, the GFP mRNA levels in liver tissue were significantly increased compared with that in the heart tissue.In the tail vein injection group, the GFP mRNA level in liver tissue reached a peak on day 7;but in the intramyocardial injection group, the mRNA level of GFP in liver tissue reached apeak on day 3.We also observed the same trend of GFP fluorescence expression in the tail vein injection group compared with that in the intramyocardial injection group.Conclusions Intramyocardial injection of adenovirus vector is suitable to achieve a higher transfection efficiency in mouse heart tissue compared with the tail vein injection method.Although both injection methods are suitable for transfection of mouse liver, the tail vein injection method is preferential for it is simple and less invasive.

Intramyocardial implantation of differentiated rat bone marrow mesenchymal stem cells enhanced by TGF-ß1 improves cardiac function in heart failure rats

The present study tested the hypotheses that i) transforming growth factor beta 1 (TGF-β1) enhances differentiation of rat bone marrow mesenchymal stem cells (MSCs) towards the cardiomyogenic phenotype and ii) intramyocardial implantation of the TGF-β1-treated MSCs improves cardiac function in heart failure rats. MSCs were treated with different concentrations of TGF-β1 for 72 h, and then morphological characteristics, surface antigens and mRNA expression of several transcription factors were assessed. Intramyocardial implantation of these TGF-β1-treated MSCs to infarcted heart was also investigated. MSCs were initially spindle-shaped with irregular processes. On day 28 after TGF-β1 treatment, MSCs showed fusiform shape, orientating parallel with one another, and were connected with adjoining cells forming myotube-like structures. Immunofluorescence revealed the expression of cardiomyocyte-specific proteins, α-sarcomeric actin and troponin T, in these cells. The mRNA expression of GATA4 and Nkx2.5 genes was slightly increased on day 7, enhanced on day 14 and decreased on day 28 while α-MHC gene was not expressed on day 7, but expressed slightly on day 14 and enhanced on day 28. Transmission electron microscopy showed that the induced cells had myofilaments, z line-like substances, desmosomes, and gap junctions, in contrast with control cells. Furthermore, intramyocardial implantation of TGF-β1-treated MSCs to infarcted heart reduced scar area and increased the number of muscle cells. This structure regeneration was concomitant with the improvement of cardiac function, evidenced by decreased left ventricular end-diastolic pressure, increased left ventricular systolic pressure and increased maximal positive pressure development rate. Taken together, these results indicate that intramyocardial implantation of differentiated MSCs enhanced by TGF-β1 improved cardiac function in heart failure rats.

Isolamento e caracterização de células-tronco obtidas de corações de camundongos adultos / Isolation and characterization of stem cells from hearts of adult mice

O uso de células-tronco representa uma alternativa para o tratamento das doenças que acometem o coração, devido à capacidade que essas células indiferenciadas têm de preservar sua própria população e de se diferenciar em células dos diversos tecidos, incluindo o cardíaco. Nesse trabalho comparamos as características de células-tronco isoladas a partir do tecido cardíaco e da medula óssea de camundongos transgênicos para a proteína fluorescente verde (GFP). As células-tronco cardíacas e da medula óssea apresentaram característica morfológica fibroblastóide e imunofenotípica de células-tronco mesenquimais, com alta expressão dos marcadores CD44, CD90, CD73, Sca-1 e baixa expressão dos marcadores de células hematopoiéticas. A análise citogenética revelou um cariótipo poliplóide a partir da terceira passagem das células-tronco isoladas do coração e da medula-óssea. A capacidade de diferenciação em vários tipos celulares, tais como adipócitos, osteócitos e condrócitos, também foi avaliada nas células-tronco de ambas as fontes. Tanto as células-tronco isoladas do coração como da medula óssea foram capazes de se diferenciar nessas três linhagens. Quando estimuladas com 5’azacitidina para testar o potencial cardiomiogênico das células isoladas do coração e da medula óssea, apenas as células-tronco cardíacas passaram a expressar alguns marcadores de cardiomiócitos, tais como troponina T cardíaca e GATA-4...

Stem cells are undifferentiated cells with the ability of self-renewal and differentiation into different cell types, with the potential to treat heart diseases. In the present study we compared the characteristics of stem cells isolated from the heart to bone marrow stem cells, both obtained from EGFP transgeneic mice. Cardiac and bone marrow stem cells presented fibroblastic morphology and an immunophenotype compatible with mesenchymal stem cells – high expression of CD44, CD90, CD73, Sca-1 and low expression of of hematopoietic lineage markers. Cytogenetic analysis demonstrated polyploid karyotypes after the third passage of the stem cells isolated from heart and bone marrow. Both bone marrow and heart stem cells were able to differentiate into adipocytes, osteocytes and chondrocytes. In order to test the potential of differentiation into cardiomyocytes, cells were stimulated with 5’azacytidine and only cardiac stem cells expressed heart-specific markers: cardiac T troponin and GATA-4...

Inhibir la contractilidad sin provocar necrosis: ¿sería útil en miocardiopatía hipertrófica? Modelo experimental de administración intramiocárdica de toxina botulínica y de wortmanina / Inhibiting contractility without necrosis: Would it be helpful for hypertrophic cardiomyopathy? Experimental model of intramyocardial botulinum toxin and wortmannin

En este artículo se presenta una idea original: inhibir la contracción miocárdica en forma regional y selectiva sin inducir necrosis. Se propone como una posible opción terapéutica en miocardiopatía hipertrófica asimétrica obstructiva, y se plantean 2 modelos farmacológicos basados en la administración intramiocárdica de toxina botulínica y de wortmanina.

The purpose of this paper is to introduce a new idea: local inhibition of contractility without necrosis. It's potential usefulness in hypertrophic cardiomyopathy treatment is discussed and 2 pharmacological models, administrating botulinum toxin and wortmannin directly in the myocardium are disclosed.

A Rare Case of Intramyocardial Lipoma / 日本心臓血管外科学会雑誌

A 72-year-old woman was admitted with a sensation of compression and shortness of breath. A mass was detected in the right atrium (RA) by transthoracic echocardiography. Preoperative chest computed tomography showed an RA tumor measuring 30×24 mm in the lateral wall. We performed resection under the cardiopulmonary bypass. Histopathological examination confirmed that this tumor was a lipoma.