Direct intramyocardial percutaneous delivery of autologous bone marrow in patients with refractory myocardial angina.

BACKGROUND: Intramyocardial injection of autologous bone marrow (ABM) may induce angiogenesis. We tested the safety and feasibility of catheter-based direct percutaneous intramyocardial delivery of ABM in patients with refractory angina pectoris. METHODS: Ten patients (9 men, 67 +/- 8 years) with refractory angina (Canadian Cardiovascular Society class III-IV) and documented myocardial ischemia were enrolled. After left ventricular electromechanical mapping, freshly aspirated and filtered ABM was percutaneously injected into target myocardial ischemic areas. Clinical symptoms (as assessed according to the Canadian Cardiovascular Society class), quality of life, and myocardial perfusion were evaluated before the procedure and through the follow-up. RESULTS: In all patients, ABM was successfully injected into the target regions. No periprocedural complications occurred. At 12 months, no major cardiac events (death, acute myocardial infarction, stroke, and malignant ventricular arrhythmias) occurred. Severity of angina improved of > or = 2 classes in 3 patients. Quality of life showed a significant improvement in all patients. Myocardial perfusion in the target regions improved in 4 of 8 patients. CONCLUSIONS: Direct percutaneous intramyocardial delivery of ABM appears feasible and safe. Further evaluation is warranted to test its clinical efficacy.

[Circumferential isolation of pulmonary veins with transcatheter radiofrequency ablation in the treatment of atrial fibrillation]. / Isolamento circonferenziale delle vene polmonari mediante ablazione transcatetere con radiofrequenza per il trattamento della fibrillazione atriale.

BACKGROUND: Circumferential anatomical isolation of the pulmonary veins by radiofrequency transcatheter ablation is a new technique for the treatment of atrial fibrillation (AF). The aim of our study was to evaluate the efficacy and the safety of circumferential radiofrequency ablation of the pulmonary veins and to analyze clinical, echocardiographic and procedural parameters as possible predictors of clinical success. METHODS: We performed circumferential isolation of the pulmonary veins in 33 patients with paroxysmal (15 patients) or persistent AF (18 patients) refractory to at least two antiarrhythmic drugs. All patients continued antiarrhythmic therapy after the procedure for at least 12 months. RESULTS: At the end of the follow-up (mean 13.7 +/- 5.1 months) 70% of the patients resulted responders to the ablation, with no differences between patients with paroxysmal and persistent AF. Complications were observed in 3% of patients. Among clinical, echocardiographic and procedural parameters analyzed none turned out to be predictor of clinical success. CONCLUSIONS: Circumferential isolation of the pulmonary veins by radiofrequency transcatheter ablation associated with antiarrhythmic drugs was efficacious in 70% of patients with either paroxysmal or persistent AF. None of the analyzed variables predicted clinical success.

Percutaneous endovascular stent-graft placement for the treatment of acute rupture of an aneurysm of the thoracic aorta.

A 68-year-old male patient presented with massive hematemesis following the acute rupture of an aneurysm of the descending thoracic aorta into the esophagus. In view of the important cardiac and pulmonary comorbidities, surgical treatment was excluded and successful percutaneous implantation of an endovascular stent-graft in the descending aorta was performed. In selected patients endovascular treatment may constitute an alternative to the surgical repair of ruptured aortic aneurysms.