A combination of omental flap and growth factor therapy induces arteriogenesis and increases myocardial perfusion in chronic myocardial ischemia: Evolving.

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A combination of omental flap and growth factor therapy induces arteriogenesis and increases myocardial perfusion in chronic myocardial ischemia: Evolving concept of biologic coronary artery bypass grafting Kiyoaki Takaba, MD, Chunli Jiang, MD, Shintaro Nemoto, MD, PhD, Yoshiaki Saji, MD, Tadashi Ikeda, MD, PhD, Shinichi Urayama, MS, Takashi Azuma, BS, Akishige Hokugo, DDS, PhD, Sadami Tsutsumi, PhD, Yasuhiko Tabata, PhD, DMedSc, DPharm, Masashi Komeda, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 132, Issue 4, Pages 891-899.e1 (October 2006) DOI: 10.1016/j.jtcvs.2006.06.023 Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Time course changes of global LV function assessed by echocardiography. FS (A) and LVEDD (B) assessed before placement of a constrictor (baseline: 0 week) and at treatment (4 weeks) and 4 weeks after treatment (8 weeks). Asterisk indicates P < .01 versus group N; dagger indicates P < .05 versus group F. N.S, Not significant. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 891-899.e1DOI: (10.1016/j.jtcvs.2006.06.023) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Regional LV function in the ischemic region assessed by cine MRI. A, Representative cine MRI images of a short-axis view at the papillary muscle level in group FG at 4 weeks after treatment. Regional myocardial thickening assessed by the modified centerline method; changes in length of cords between end-diastole and end-systole determine wall thickening. RV, Right ventricular cavity; LV, left ventricular cavity; Cx, circumflex artery. B, Percent wall thickening in the ischemic region assessed by cine MRI analysis at 4 weeks after treatment in each group. Asterisk indicates P < .01 versus group N; dagger indicates P < .05 versus group F. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 891-899.e1DOI: (10.1016/j.jtcvs.2006.06.023) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Regional myocardial blood flow (rMBF) in the LCx region assessed by the colored microsphere technique. A, rMBF in LCx region at 4 weeks after each treatment assessed by colored microsphere technique. Asterisk indicates P < .01 versus group N; dagger indicates P < .05 versus group F. B, The change of rMBF in the LCx region in group FG before and after clamping the GEA pedicle. Asterisk indicates P < .01. ANOVA, Analysis of variance. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 891-899.e1DOI: (10.1016/j.jtcvs.2006.06.023) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Histologic assessment of arteriogenesis in the ischemic myocardium after treatment. A, Representative images of immunohistochemical staining in group F and group FG. Arterioles in the LCx region were stained with α-smooth muscle actin antibody. Arrows indicate arterioles with a diameter more than 50 μm. Scale bar indicates 100 μm in length (original magnification ×100). B, Quantification of the number of arterioles with a diameter more than 50 μm in each group. Asterisk indicates P < .01 versus group N; dagger indicates P < .05 versus group F. ANOVA, Analysis of variance. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 891-899.e1DOI: (10.1016/j.jtcvs.2006.06.023) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Microvascular corosion cast image of collateral formation in group FG. A, The whole specimen. Representative image of a microvascular corosion cast specimen in group FG. Scale bar indicates 10 mm in length (original magnification ×6). Cx, Left circumflex artery; GEA, gastroepiploic artery. B, Representative image of collateral formation between distally occluded LCx and GEA. Scale bar indicates 1 mm in length. (Original magnification ×60). C, Scanning electron micrographs of collaterals between distally occluded LCx and GEA in the microvascular corrosion cast specimens. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 891-899.e1DOI: (10.1016/j.jtcvs.2006.06.023) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions