ABSTRACT
Pioneering work in cardiac cell and gene transfer has primarily been conducted either surgically 1, 2 or through in tracoronary infusion. 3, 4 While the open surgical approach offers visual feedback for locating and controlling injections, the target patient populations, those with recent myocardial infarction or advanced heart failure, are typically at higher risk for major complications, encountered when conventional surgical approaches and general anesthesia are used. Intracoronary injection is less specific than direct injections. Furthermore, the therapeutic yield may be limited by the presence of advanced coronary disease, which may in fact direct cells to non-target regions of the myocardium. Finally, transendothelial cell migration has yet to be well demonstrated, and with larger cells, such as skeletal myoblasts, the risk of distal embolization is theoretically high. The indications for new therapies such as direct intramyocardial cell and gene therapy might be significantly expanded if a straightforward, repeatable and expeditious percutaneous technique could be identified.
