• Images in cardiology

A 57 year old man was admitted to our hospital with acute anterolateral myocardial infarction. He was treated with intravenous thrombolysis within 120 minutes after the initial chest pain. Creatine phosphokinase peaked at 1890 U/l after six hours. Coronary angiography obtained five days post-infarction demonstrated one vessel left anterior descending artery (LAD) disease not requiring balloon angioplasty. Echocardiography revealed apical and mid anterolateral hypo- to akinesia that was in accordance with an anterolateral defect in the Tc99m-MIBI rest technique. Six weeks post-infarction 600 ml of bone marrow were harvested from the patient’s hipbone. NOGA non-fluoroscopic electromechanical mapping (Biosense Webster) at this time showed significantly reduced voltage values in the anterior, anterolateral and septal regions, indicated by the red colour (panel A). A total of 2 × 10⁹ bone marrow mononuclear cells (5.2 ml) were implanted at 12 sites into the transition zone between scar and viable myocardium by NOGA guided injection.

In the six month follow up NOGA, the anteroseptal and anterolateral region was green-yellow, suggesting improved viability in these areas (panel B). Myocardial perfusion and viability imaging using the stress and glyceryl trinitrate enhanced Tc99m-MIBI rest technique showed a decrease in resting defect size from 34% to 25%. LAD territorial extent—that is, uptake extent in the area-of-risk—had decreased from 65% to 46%. Left ventricular ejection fraction obtained by gated single photon emission computed tomography had improved from 33% to 41%.

The data demonstrate improved viability and perfusion six months after anterior myocardial infarction and percutaneous intramyocardial autologous bone marrow transplantation.

NOGA baseline unipolar voltage map before (panel A) and six months after bone marrow transplantation (panel B). Red areas represent electrical activity below 5 mV, indicating low viability (colour bar ranging from red < 5mV to purple > 15 mV). Brown dots mark the intramyocardial injection sites.