This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Möllmann, H. Articles by Elsässer, A. Search for Related Content PubMed PubMed Citation Articles by Möllmann, H. Articles by Elsässer, A. Related Collections Structure Remodeling Cell biology/structural biology Smooth muscle proliferation and differentiation Catheter-based coronary and valvular interventions: other Related Article

(Circulation. 2006;113:e718-e719.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

Natural Tissue Engineering Inside a Ventricular Septum Defect Occluder

Helge Möllmann, MD^*; Holger M. Nef, MD^*; Sawa Kostin, MD; Woitek Skwara, MD; Jutta Schaper, MD; Christian W. Hamm, MD; Albrecht Elsässer, MD

From the Kerckhoff Heart Centre, Department of Cardiology (H.M., H.M.N., C.W.H., A.E.); the Max Planck Institute for Heart and Lung Research (S.K., J.S.); and the Kerckhoff Heart Centre, Department of Cardiac Surgery (W.S.), Bad Nauheim, Germany.

Correspondence to Dr Helge Möllmann, Kerckhoff Heart Centre, Benekestrasse 2-8, 61231 Bad Nauheim, Germany. E-mail h.moellmann@kerckhoff.mpg.de

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Eighteen days after having received conservative treatment for a myocardial infarction, a 65-year-old patient developed acute right heart failure caused by a ventricular septal rupture. Progressive multiorgan failure contraindicated open heart surgery. Therefore, we implanted a ventricular septal defect occluder via a venous approach as an emergency intervention, thereby achieving stabilization of the patient within 24 hours. After another 6 weeks, an aneurysmectomy was planned because a remarkable aneurysm of the anterior wall, including the part of the septum in which the occluder was located, was detected by echocardiography and magnetic resonance imaging. During open heart surgery, the occluder was removed (Figure 1), and a Dor procedure was performed in addition to aortocoronary bypass grafting.

View larger version (82K): [in this window] [in a new window]   Figure 1. Intraoperative findings. A, Removal of the ventricular septal defect occluder. B, Ventricular septal rupture within the scar tissue after myocardial infarction.

After accurately cutting through the occluder, an immunohistochemistry study was performed (Figure 2). Tissue formation was observed on the nitinol arms of the occluder. The boundaries of this newly formed tissue were mainly defined by smooth muscle cells. The portion of tissue extending to the left ventricle was more multilayered and consequently wider than that on the right ventricular side. The space between the smooth muscle layers was filled with numerous macrophages, fibroblasts, myofibroblasts, lymphocytes, and most interestingly, vascular structures. Angiogenesis was pronounced, and the presence of numerous macrophages and lymphocytes suggested that active inflammatory processes had occurred during the formation of this viable tissue.

View larger version (71K): [in this window] [in a new window]   Figure . . . [Full Text of this Article]

Related Article:

Issue Highlights
Circulation 2006 113: 1921. [Extract] [Full Text]