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(Circulation. 1999;100:2462.)
© 1999 American Heart Association, Inc.

Images in Cardiovascular Medicine

Percutaneous Myocardial Gene Transfer of phVEGF-2

Peter R. Vale, MD; Douglas W. Losordo, MD; Charles E. Milliken, MS; Darryl D. Esakof, MD; Jeffrey M. Isner, MD

From the Departments of Medicine and Cardiovascular Research, St Elizabeth’s Medical Center, Tufts University School of Medicine, Boston, Mass.

Correspondence to Jeffrey M. Isner, MD, St Elizabeth’s Medical Center, 736 Cambridge St, Boston, MA 02135. E-mail jisner{at}opal.tufts.com

Gene transfer of phVEGF-2, an endothelial cell mitogen previously shown to promote angiogenesis in preclinical animal studies, is intended to promote collateral vessel development to the ischemic lateral LV wall. The strategy of gene delivery used in this case is designed to exploit the fact that muscle, particularly myocardium, yields relatively higher levels of gene expression than other tissue types; electromechanical mapping was used in this case to guide injection to sites of myocardial ischemia, because ischemic muscle yields even higher levels of gene expression. The patient was an 82-year-old man with coronary heart disease, including an old anteroseptal myocardial infarction (MI), previous coronary artery bypass surgery, and chronic angina refractory to medical therapy.

View larger version (42K): [in this window] [in a new window]   Figure 1. Percutaneous myocardial gene transfer of phVEGF-2. Panels of this composite figure depict various aspects of first human application of percutaneous myocardial gene transfer. A, Electromechanical (NOGA) map pair of left ventricle (LV) in left lateral view obtained with an endocardial mapping catheter. Color-coded voltage map on left shows that myocardial viability of lateral LV wall is preserved; linear local shortening map on right, however, shows that mechanical function of basal portion of lateral wall (red-orange) is impaired. Map pair thus suggests area of hibernating myocardium. B, Apical 2-chamber view from transthoracic echocardiogram showing thinning of ventricular septum (VS) (arrow) and apex of LV due to old MI. These sites would thus not be appropriate for gene transfer. C, Photograph of modified mapping-injection catheter (Biosense, Johnson & Johnson). Electrode at distal catheter tip allows annotation of electromechanical map to document sites of injection (gene transfer). In catheter shown on right, 27-gauge needle has been advanced out of distal catheter tip to simulate myocardial engagement in preparation for injection. D, Posteroanterior view recorded during cine-fluoroscopy shows distal tip of injection catheter (arrow) positioned against endocardium of lateral LV wall in preparation for injection; 27-gauge needle, advanced into LV myocardium, is not visible. E, Electromechanical (NOGA) map pair of LV in left lateral view after total of 6 injections of naked DNA encoding for vascular endothelial growth factor-2 (VEGF-2). Injection sites have been successfully positioned at border of ischemic myocardium, indicated by red bullets on map pair.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

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