RESUMO
Stem cell transplantation is a new therapy applied to produce cardiac regeneration through differentiation or increase of heart myocytes or neovascular proliferation in patients in the end stage of congestive heart failure secondary to dilated cardiomyopathy, but the results are still unknown.
Assuntos
Cardiomiopatia Chagásica/cirurgia , Insuficiência Cardíaca/cirurgia , Leucócitos Mononucleares/transplante , Coloração e Rotulagem , Transplante de Células-Tronco/métodos , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/cirurgia , Cardiomiopatia Chagásica/complicações , Cardiomiopatia Chagásica/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Cintilografia , Compostos Radiofarmacêuticos , Células-Tronco/citologia , Células-Tronco/fisiologia , Tecnécio Tc 99m SestamibiRESUMO
O transplante de células-tronco é uma nova terapia com objetivo de produzir regeneração cardíaca pela diferenciação ou aumento dos miócitos cardíacos ou proliferação neovascular em pacientes no estágio final de insuficiência cardíaca congestiva secundária a cardiomiopatia dilatada¹, mas os resultados são desconhecidos2,3.
Stem cell transplantation is a new therapy applied to produce cardiac regeneration through differentiation or increase of heart myocytes or neovascular proliferation in patients in the end stage of congestive heart failure secondary to dilated cardiomyopathy¹, but the results are still unknown2,3.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Cardiomiopatia Chagásica/cirurgia , Insuficiência Cardíaca/cirurgia , Leucócitos Mononucleares/transplante , Coloração e Rotulagem , Transplante de Células-Tronco/métodos , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada , Cardiomiopatia Dilatada/cirurgia , Cardiomiopatia Chagásica/complicações , Cardiomiopatia Chagásica , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca , Compostos Radiofarmacêuticos , Células-Tronco/citologia , Células-Tronco/fisiologiaRESUMO
We report a rare case of anomalous origin of the left coronary artery from the pulmonary trunk in a 45-year-old woman. The approach and technique used for selective catheterization of an anomalous left coronary artery arising from the pulmonary trunk are described. Six years after diagnosis, echocardiography showed left ventricular disfunction, and surgical treatment was indicated again. The origin of the left coronary artery from the pulmonary trunk was closed, and the postoperative period was uneventful, with recovery of left ventricular function and disappearance of ischemic features on stress myocardial perfusion imaging with 99m Tc-sestamibi, performed 4 weeks after surgery.
Assuntos
Anomalias dos Vasos Coronários/diagnóstico , Artéria Pulmonar/anormalidades , Anomalias dos Vasos Coronários/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Artéria Pulmonar/cirurgiaRESUMO
We report a rare case of anomalous origin of the left coronary artery from the pulmonary trunk in a 45-year-old woman. The approach and technique used for selective catheterization of an anomalous left coronary artery arising from the pulmonary trunk are described. Six years after diagnosis, echocardiography showed left ventricular disfunction, and surgical treatment was indicated again. The origin of the left coronary artery from the pulmonary trunk was closed, and the postoperative period was uneventful, with recovery of left ventricular function and disappearance of ischemic features on stress myocardial perfusion imaging with 99m Tc-sestamibi, performed 4 weeks after surgery
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Anomalias dos Vasos Coronários , Artéria Pulmonar , Anomalias dos Vasos Coronários , Artéria PulmonarRESUMO
BACKGROUND: This investigation tested the application of low-dose dobutamine (LDD) gated single photon emission computed tomography (SPECT) with thallium 201 for myocardial viability detection early after acute myocardial infarction (AMI). METHODS AND RESULTS: Thirty-two hemodynamically stable post-AMI patients (aged 55 +/- 5 years [mean +/- SEM]; 20 men) who were exhibiting regional left ventricular dysfunction underwent stress-redistribution Tl-201 scanning within 4 to 8 days, followed by 2 additional gated SPECT acquisitions after Tl-201 reinjection, at rest and during LDD. A visual 5-point score was computed for segmental radiotracer uptake (0, normal; 4, absent) and a 4-point score for left ventricular wall motion (1, normal; 4, dyskinesis). Predominant viable myocardium in dyssynergic regions was predicted by a mean Tl-201 uptake score of 2 or less or ischemic area of 30% or greater. These indices showed a significant association with wall motion improvement in follow-up echocardiographic studies (overall accuracy = 0.69, sensitivity = 0.93, and specificity = 0.50). Regarding the response to LDD stimulus, an increase in mean wall motion score of 30% or greater was predictive of predominant viable myocardium. Contractile reserve assessment yielded a significant increment in the predictive accuracy for function recovery (overall accuracy = 0.84, sensitivity = 0.71, and specificity = 0.94). CONCLUSIONS: Evaluation of contractile reserve by means of LDD gated SPECT with Tl-201 is safely feasible early after AMI, with incremental value over perfusion assessment alone for myocardial viability detection.