ABSTRACT
The left ventricular summit (LVS) refers to the highest portion of the left ventricular outflow tract (LVOT). It is an epicardially delimited triangular area by the left coronary arteries and the coronary venous circulation. Its deep myocardium correlates closely with the left coronary cusp, aortic-mitral continuity, and right ventricular outflow tract (RVOT), complicating the anatomical relationship. Ventricular arrhythmias (VAs) originating from this area are common, accounting for 14.5% of all VAs origin from left ventricle. Specific electrocardiogram (ECG) characteristics may assist in locating LVS-VAs pre-procedure and facilitate procedure planning. However, catheter ablation of LVS-VAs remains challenging because of anatomical constraints. This paper reviews the recent understanding of LVS anatomy, concludes ECG characteristics, and summarizes current mapping and ablation methods for LVS-VAs.
Subject(s)
Catheter Ablation , Tachycardia, Ventricular , Humans , Heart Ventricles/surgery , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/surgery , Arrhythmias, Cardiac , Aorta/surgery , Myocardium , Catheter Ablation/methods , Electrocardiography/methods , Treatment OutcomeABSTRACT
We have evaluated the safety and efficacy of intracoronary human umbilical cord-derived mesenchymal stem cell (hUCMSC) treatment for very old patients with coronary chronic total occlusion. hUCMSCs could improve in the degree of ischemic myocardium, decrease in the infarct size and rise in left ventricular ejection fraction, but the involved mechanisms remain to be fully identified. We analyzed levels of circulating leukocytes, highsensitivity C-reactive protein (hs-CRP), interleukins (ILs), tumor necrosis factor-a (TNF-a), soluble tumor necrosis factor receptor-1 (sTNFR-1), soluble tumor necrosis factor receptor-2 (sTNFR-2), NT-proBNP, BNP, angiotensin 1-7 (Ang1-7), angiotensin II (Ang II) and aldosterone (Ald) in patients with hUCMSC therapy at baseline, 12, and 24 months. Levels of Ang1-7, IL-10, IL-37 and IL-17 were increased at 12 months and 24 months; leukocytes, hs- CRP, IL-1.
Subject(s)
Coronary Occlusion/surgery , Mesenchymal Stem Cell Transplantation/methods , Ventricular Function, Left , Aged, 80 and over , Aldosterone/blood , Angiotensins/blood , Aprotinin/blood , Biomarkers/blood , Echocardiography , Exercise Test , Humans , Interleukins/blood , Ventricular Function, Left/physiologyABSTRACT
This study aimed to investigate the safety and feasibility of intracoronary injection of human umbilical cord mesenchymal stem cell to the very old patients with coronary chronic total occlusion. 15 consecutive patients received mesenchymal stem cells from human umbilical cord in epicardial coronary artery supplying collateral circulation. The patients were randomly allocated to low-dose 3x10(6), mid-dose 4x10(6) and high-dose 5x10(6) groups. (99m)Tc single photon emission computed tomography images were obtained at 12 and 24 months. During the 24 month study period, no cases of major cardiac adverse events were reported. None of the patients had coronary care unit admissions hospitalizations further coronary revascularization acute myocardial infarction and death. The patients had a significant reduction of the infarct size and a remarkable rise in left ventricular ejection fraction with respect to secondary outcomes. This study suggested that stem cell transplantation was safe and feasible. The cells can be utilized to improve in the degree of ischemic myocardium, decrease in the infarct size and rise in left ventricular ejection fraction.