Endogenous myocardial angiogenesis and revascularization using a gastric submucosal patch Marc A Ruel, MD, MPh, Frank W Sellke, MD, Cesario Bianchi,

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Endogenous myocardial angiogenesis and revascularization using a gastric submucosal patch Marc A Ruel, MD, MPh, Frank W Sellke, MD, Cesario Bianchi, MD, PhD, Tanveer A Khan, MD, Renato Faro, PhD, Jian-Ping Zhang, MD, William E Cohn, MD The Annals of Thoracic Surgery Volume 75, Issue 5, Pages 1443-1449 (May 2003) DOI: 10.1016/S0003-4975(02)04708-2 Copyright © 2003 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Experimental model. In test animals, a submucosal gastric patch based on a gastroepiploic arteriovenous pedicle (GEA) was transferred through the diaphragm and apposed directly against the lateral myocardium, made ischemic by the placement of an ameroid constrictor (A) around the left circumflex artery (LCx). Control animals underwent circumflex ameroid placement and abrasion of the lateral epicardium, but did not receive a submucosal gastric patch. The Annals of Thoracic Surgery 2003 75, 1443-1449DOI: (10.1016/S0003-4975(02)04708-2) Copyright © 2003 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Relative indices of myocardial perfusion determined with isotope-labeled microspheres. The perfusion ratios of collateral-dependent (LCx) over normal (LAD) myocardial territories were equivalent in the two groups at rest (1.10 ± 0.49 versus 0.95 ± 0.23, test [white bars] versus control [black bars] animals; p = 0.54), but were higher in test animals versus controls during pacing (1.05 ± 0.29 versus 0.69 ± 0.09, test versus controls; *p = 0.02). The Annals of Thoracic Surgery 2003 75, 1443-1449DOI: (10.1016/S0003-4975(02)04708-2) Copyright © 2003 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Gastroepiploic (GEA) arteriogram of a test animal at seven weeks. Patch contour (P), circumflex artery occlusion at the ameroid constrictor (A) level and reconstitution (LCx) from the patch, and drainage of contrast through the coronary sinus (CS) were observed. The Annals of Thoracic Surgery 2003 75, 1443-1449DOI: (10.1016/S0003-4975(02)04708-2) Copyright © 2003 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Lectin-positive endothelial cells (arrows) in the left circumflex territory at 7 weeks. Increased endothelial cell density was observed in test (T) animals (left) versus controls (C) (right). The Annals of Thoracic Surgery 2003 75, 1443-1449DOI: (10.1016/S0003-4975(02)04708-2) Copyright © 2003 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Representative immunoblots of VEGFR-1 and VE-Cadherin expression in collateral-dependent myocardial territories at 7 weeks. Expression of the endothelial cell marker VE-Cadherin was significantly increased in test (T) animals versus controls (C). The Annals of Thoracic Surgery 2003 75, 1443-1449DOI: (10.1016/S0003-4975(02)04708-2) Copyright © 2003 The Society of Thoracic Surgeons Terms and Conditions