The limited ability of the human heart to regenerate cardiomyocytes results in heart failure following the cellular death that occurs during a myocardial infarction. The techniques of conventional cardiac revascularization (coronary artery bypass grafting or percutaneous coronary interventions) require the target area to have suitable vessels and viable myocardium. In some instances these requirements, either individually or in conjunction, are unable to be met. Therefore, other methods have been developed to aid persons deemed unsuitable for conventional revascularization. Cardiac cell transplantation in animal models has been shown to improve angiogenesis and ventricular elasticity and may improve the electromechanical coupling of myocytes. The danger of harvesting and then transplanting cardiomyocytes from an already damaged heart is of tremendous clinical concern. In addition, immunologic and ethical concerns hinder the transplantation of fetal cardiomyocytes. The hypothesis of this project is that significant levels of angiogenesis and increased improvement of cardiac function can be achieved by using smooth muscle cell transplantation following ischemia to the myocardium. A model of chronic myocardial ischemia was created by a small left thoracotomy in which an ameroid constrictor was placed around the proximal left circumflex artery. Left ventricular function was assessed by rest and dobutamine stress echocardiography as well as contrast-enhanced and cine magnetic resonance imaging scans. Also, tissue samples were sent for histological analysis. MRI data demonstrate a trend toward increased functional improvement of the treated tissue. The results of this experiment will be compared with future angiogenic studies conjunctively utilizing smooth muscle cell transplantation and transmyocardial laser revascularization.
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