Endogenous myocardial angiogenesis and revascularization using a gastric submucosal patch

Ann Thorac Surg. 2003 May;75(5):1443-9. doi: 10.1016/s0003-4975(02)04708-2.


Background: The gastrointestinal submucosa physiologically produces angiogenic proteins. We examined whether these properties could lead to endogenous myocardial angiogenesis in a swine model of chronic ischemia.

Methods: Fifteen Yorkshire swine underwent ameroid constrictor placement around the circumflex artery and either lateral epicardial abrasion, creation of a gastroepiploic artery (GEA) based gastric patch, mucosal avulsion, transdiaphragmatic transfer, and apposition of the patch against the circumflex myocardial territory (number = 8; test animals), or lateral epicardial abrasion alone (number = 7; controls). Seven weeks later, lateral myocardial perfusion, endothelial cell density, and expression of VEGFR-1 and VE-cadherin were determined using isotope-labeled microsphere assays, immunohistochemistry, and immunoblotting, respectively.

Results: Microsphere assays showed equivalent lateral/anterior myocardial perfusion indices at rest (1.10 +/- 0.49 vs 0.95 +/- 0.23, test vs control animals; p = 0.54), but higher perfusion in test animals versus controls during pacing (1.05 +/- 0.29 vs 0.69 +/- 0.09, test vs controls; p = 0.02). Increased myocardial endothelial cell density (42.6 +/- 8.5 vs 26.1 +/- 11.6 cells per 3850 microm2, test vs controls; p = 0.02) and expression of VE-cadherin (3.10 +/- 0.60-fold change, test vs controls; p = 0.001) were also observed in the lateral territory of test animals versus controls. Reconstitution of the proximally occluded circumflex artery from patch collaterals was demonstrated on gastroepiploic arteriography in a subset of test animals.

Conclusions: This model results in an angiogenic process of significantly greater magnitude than that resulting from chronic myocardial ischemia alone, without the need for exogenous angiogenic agents.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Animals
  • Antigens, CD
  • Cadherins / analysis
  • Collateral Circulation
  • Coronary Circulation
  • Coronary Vessels / chemistry
  • Coronary Vessels / pathology
  • Coronary Vessels / physiology*
  • Coronary Vessels / surgery
  • Endothelium, Vascular / pathology
  • Female
  • Immunoblotting
  • Immunohistochemistry
  • Myocardial Ischemia / physiopathology
  • Myocardial Ischemia / therapy*
  • Neovascularization, Physiologic*
  • Stomach / transplantation*
  • Surgical Flaps / blood supply*
  • Swine
  • Vascular Endothelial Growth Factor Receptor-1 / analysis


  • Antigens, CD
  • Cadherins
  • cadherin 5
  • Vascular Endothelial Growth Factor Receptor-1