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Intramyocardial Navigation and Mapping for Stem Cell Delivery

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Abstract

Method for delivery remains a central component of stem cell-based cardiovascular research. Comparative studies have demonstrated the advantages of administering cell therapy directly into the myocardium, as distinct from infusing cells into the systemic or coronary vasculature. Intramyocardial delivery can be achieved either transepicardially or transendocardially. The latter involves percutaneous, femoral arterial access and the retrograde passage of specially designed injection catheters into the left ventricle, making it less invasive and more relevant to wider clinical practice. Imaging-based navigation plays an important role in guiding catheter manipulation and directing endomyocardial injections. The most established strategy for three-dimensional, intracardiac navigation is currently endoventricular, electromechanical mapping, which offers superior spatial orientation compared to simple x-ray fluoroscopy. Its provision of point-by-point, electrophysiologic and motion data also allows characterization of regional myocardial viability, perfusion, and function, especially in the setting of ischemic heart disease. Integrating the mapping catheter with an injection port enables this diagnostic information to facilitate the targeting of intramyocardial stem cell delivery. This review discusses the diagnostic accuracy and expanding therapeutic application of electromechanical navigation in cell-based research and describes exciting developments which will improve the technology’s sensing capabilities, image registration, and delivery precision in the near future.

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Acknowledgements

The authors thank Dr. Emerson Perin and Mr. Fred Baimbridge (Texas Heart Institute, Houston, TX, USA) for kindly providing the image in Fig. 3. The authors have no financial conflicts to report. Dr. Psaltis is supported by a Postgraduate Medical Scholarship from the National Health and Medical Research Council of Australia (ID 390711) and the National Heart Foundation of Australia (PB 05A 2312) and a Dawes Scholarship from the Royal Adelaide Hospital.

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  1. Cardiovascular Research Centre, Department of Cardiology, Royal Adelaide Hospital and the Department of Medicine, University of Adelaide, Adelaide, South Australia, 5000, Australia

    Peter J. Psaltis & Stephen G. Worthley

  2. Bone and Cancer Laboratories, Division of Haematology, Institute of Medical and Veterinary Science/Hanson Institute & Centre for Stem Cell Research, Robinson Institute, University of Adelaide, Adelaide, Australia

    Peter J. Psaltis, Andrew C. W. Zannettino & Stan Gronthos

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Psaltis, P.J., Zannettino, A.C.W., Gronthos, S. et al. Intramyocardial Navigation and Mapping for Stem Cell Delivery. J. of Cardiovasc. Trans. Res. 3, 135–146 (2010). https://doi.org/10.1007/s12265-009-9138-1

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  • DOI: https://doi.org/10.1007/s12265-009-9138-1

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