ABSTRACT
Heart failure (HF) is the leading cause of death worldwide. Efforts to decrease HF mortality rates include a multidisciplinary approach management. Although evidence suggests that this has been an optimal strategy for treating HF, the model remains not widely implanted. The current article explores the rationale behind the formation of a Heart Team in a developing country and its development despite the lack of an allocated budget.
Subject(s)
Cardiology , Heart Failure/therapy , Patient Care Team , Cardiology/organization & administration , Heart Failure/mortality , Humans , Mexico/epidemiologyABSTRACT
Autologous transplant of bone marrow stem cells (BMSC), although extremely useful after acute myocardial events, has not been evaluated in patients with old (>one-year-old) myocardial infarction. Our aim was to determine if CD34(+)-enriched peripheral-blood cells, obtained by apheresis, injected directly into the severely damaged myocardium of five patients with old myocardial infarction could restore depressed myocardial function. We found that 28 weeks after revascularization and peri-infarction injection of the enriched CD34(+) peripheral mononuclear cells, ventricular hemodynamic parameters that included left ventricular ejection fraction, left ventricular diastolic volume, ventricular systolic volume and left ventricular diastolic diameter approximated normal values and there was no restenosis; two patients have been followed for >52 weeks and their parameters are within normal values. In conclusion, intramyocardial injection of easily obtained CD34(+) enriched peripheral blood cells represent an encouraging procedure for patients with severely scarred and dysfunctional myocardium.
Subject(s)
Bone Marrow Cells/cytology , Granulocyte Colony-Stimulating Factor/therapeutic use , Hematopoietic Stem Cell Transplantation , Myocardial Infarction/surgery , Adult , Antigens, CD34/metabolism , Bone Marrow Cells/drug effects , Bone Marrow Cells/metabolism , Filgrastim , Granulocyte Colony-Stimulating Factor/administration & dosage , Heart/diagnostic imaging , Hematopoietic Stem Cell Mobilization , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/physiopathology , Myocardial Revascularization , Radionuclide Imaging , Recombinant Proteins , Time Factors , Transplantation, Autologous , Treatment Outcome , Ventricular Function, LeftABSTRACT
El trasplante del corazón es una modalidad de tratamiento poco frecuente en la cardiopatía congénita avanzada. Se presenta el caso de un joven de 17 años portador de una tetralogía de Fallot dilatada y en fase terminal a quien se hizo trasplante ortotópico del corazón; se presentan los datos más relevantes de su manejo a los 53 meses de postoperatorio y se discute la perspectiva a largo plazo, que es comparable a la esperada en los enfermos trasplantados por otros padecimientos cardiacos.
