ABSTRACT
INTRODUCTION: Cryopreserved tissue allografts used for cardiovascular diseases become calcified as a late complication after transplantation, probably caused by immunological rejection. Recent attention has been focused on the inhibitory effect of matrix Gla protein (MGP) on ectopic vascular calcification, but the behavior of MGP in cryopreserved allografts is uncertain. In this study we examined the relationship between immunological rejection and MGP in cryopreserved rat aortic grafts after transplantation. METHODS: Cryopreserved rat aortae were isografted or allografted intraperitoneally. Fresh isografts were also tested. The grafts were retrieved 9 days after transplantation and the intragraft MGP mRNA was measured by a real-time quantitative PCR method. The effect of daily administration of FK506 on MGP mRNA levels in cryopreserved isografts and allografts after transplantation was also evaluated. RESULTS: There was no significant difference in intragraft MGP mRNA levels between fresh and cryopreserved isografts 9 days after transplantation. MGP expression levels in cryopreserved allografts were significantly lower as compared to those in cryopreserved isografts (P < .01). Daily administration of FK506 enhanced intragraft MGP mRNA (ninefold) in cryopreserved allografts (P < .01), but not in cryopreserved isografts. CONCLUSIONS: Immunological rejection is likely to inhibit MGP expression in cryopreserved vascular allografts, resulting in late-onset calcification.
Subject(s)
Aorta/transplantation , Calcium-Binding Proteins/genetics , Extracellular Matrix Proteins/genetics , Graft Rejection/immunology , Animals , Cryopreservation , Immunosuppressive Agents/therapeutic use , Male , Polymerase Chain Reaction , RNA, Messenger/genetics , Rats , Rats, Inbred BN , Rats, Inbred Lew , Tacrolimus/therapeutic use , Transplantation, Homologous/immunology , Matrix Gla ProteinABSTRACT
PURPOSE: The purpose of this study was to investigate the survival of xenogeneic embryonic stem cell (ES cell)-derived cardiomyocytes transplanted into the normal myocardium. MATERIAL AND METHODS: Undifferentiated mouse ES cells carrying the enhanced green fluorescent protein (EGFP) were cultured in hanging drops and then plated onto dishes. These cells were identified as cardiomyocytes by the expression of cardiac-specific genes, recording of action potential, and immunostaining with anti-sarcomeric myosin antibody. Donor cells were injected into the normal myocardium, with cyclosporine administered daily. One week after the transplantation, we investigated donor cell survival by examining EGFP expression, hematoxylin and eosin staining, and immunostaining with anti-sarcomeric myosin antibody. RESULTS: In vitro donor cells derived from ES cells expressed myosin light chain-2v and alpha-myosin heavy chain genes, had action potentials of a ventricular myocyte type, and were stained by anti-sarcomeric myosin antibody. In vivo 1 week after transplantation, EGFP-expressed cells were detected in the cell transplanted area. No lymphocytic infiltration was observed around these cells. CONCLUSIONS: ES cell-derived cardiomyocytes survived in the normal myocardium after the transplantation, even in a discordant xenogeneic transplantation model. These results indicate that cell transplantation using cardiomyocytes derived from ES cells, even if xenogeneic represents an attractive strategy for treating heart disease.
Subject(s)
Heart Transplantation/methods , Heart/embryology , Muscle Cells/transplantation , Stem Cell Transplantation/methods , Transplantation, Heterologous , Action Potentials , Cell Differentiation , Cell Division , Hematopoietic Stem Cells/cytology , Hematopoietic Stem Cells/physiology , Humans , Muscle Cells/cytology , Muscle Cells/physiologySubject(s)
Aorta, Thoracic/immunology , Aorta, Thoracic/transplantation , Cytokines/genetics , Endothelial Growth Factors/genetics , Intercellular Signaling Peptides and Proteins/genetics , Lymphokines/genetics , Polymerase Chain Reaction/methods , Transplantation, Homologous/physiology , Animals , Base Sequence , Cell Survival , Cryopreservation/methods , DNA Primers , Fibroblast Growth Factor 2/genetics , Hepatocyte Growth Factor/genetics , Rats , Rats, Inbred Lew , Transplantation, Homologous/immunology , Vascular Endothelial Growth Factor A , Vascular Endothelial Growth FactorsSubject(s)
Aorta, Thoracic/transplantation , Endothelial Growth Factors/genetics , Gene Expression Regulation , Intercellular Signaling Peptides and Proteins/genetics , Lymphokines/genetics , Regeneration/genetics , Transplantation, Isogeneic/physiology , Animals , Cryopreservation/methods , Glyceraldehyde-3-Phosphate Dehydrogenases/genetics , Hepatocyte Growth Factor/genetics , Kinetics , Male , Rats , Rats, Inbred BN , Time Factors , Vascular Endothelial Growth Factor A , Vascular Endothelial Growth FactorsABSTRACT
We report a case of multiple coronary artery bypass grafting (CABG) via a left thoracotomy without cardiopulmonary bypass. A 54-year-old female with unstable angina pectoris associated with left main trunk disease underwent emergency CABG. Because the patient had a history of total arch and aortic root replacement due to type A aortic dissection, a left thoracotomy approach was selected. The proximal end of the Y-shaped saphenous vein graft was anastomosed to the left subclavian artery, rather than to the descending aorta, owing to the remaining aortic dissection. The distal end of the Y-shaped saphenous vein graft was anastomosed to the left anterior descending artery and the posterolateral branch without cardiopulmonary bypass. The postoperative course was uneventful. The results of this surgery seem to indicate that off-pump CABG via a left thoracotomy is a viable technique, especially for patients undergoing repeat CABG.
Subject(s)
Aortic Aneurysm/surgery , Aortic Dissection/surgery , Coronary Artery Bypass/methods , Coronary Disease/surgery , Angina, Unstable/complications , Cardiac Surgical Procedures/methods , Female , Humans , Middle Aged , Reoperation , ThoracotomyABSTRACT
We analyzed the left ventricular hemodynamic changes after aortic valve replacement using Medtronic Freestyle stentless valve. Doppler echocardiograms were performed at three weeks and three months after operation in twelve patients. Both left ventricular end-diastolic volume (index) and left ventricular end-systolic volume (index) were decreased respectively. Fractional shortening were markedly increased from 21.4 +/- 7% to 31.8 +/- 3.8%, and left ventricular mass index were markedly decreased from 194.3 +/- 25.3 g/m2 to 182.3 +/- 24.4 g/m2. Transvalvular pressure gradient measured by cardiac catheterization were almost zero mmHg at three weeks after operation. No aortic regurgitation were found in all cases. Good left ventricular remodeling were obtained so that we believe this valve could be acceptable alternative for many surgeons. These excellent results justify wider use of stentless valve.
