1. Hybrid Surgical Angiogenesis: Omentopexy Can Enhance Myocardial Angiogenesis Induced by Cell Therapy 
Taro Kanamori, MD, Go Watanabe, MD, Tamotsu Yasuda, MD, Hiroshi Nagamine, MD, Hiroyuki Kamiya, MD, Yoshinao Koshida, MD 
The Annals of Thoracic Surgery 
Volume 81, Issue 1, Pages (January 2006)
DOI: /j.athoracsur
Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
Experimental model. After myocardial infarction at the lateral wall area was generated, bone marrow-derived mononuclear cells (total 1.2 × 108 cells, 6.0 × 106 cells /0.2 mL/site × 20 sites) were injected directly into the myocardium including the infarct area and peri-infarct area with a width of approximately 1 cm from the borderline. After injection, epicardiectomy was performed and the omental flap passed through the diaphragm was wrapped directly around the injected area.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
Regional fractional shortening (RFS) at three periods (preinfarction, before injection, three weeks after injection) is shown. Before injection, severe deterioration of the RFS was observed in all animals. Three weeks after injection, the RFS of the bone marrow (BM) group and the BM+Oment group were significantly improved as compared with those before injection each. There was no significant difference between BM group and BM+Oment group. *p < 0.01 vs RFS before injection. (Oment = omentopexy.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
Relative regional myocardial blood flow (RMBF) at rest (left) and under stress (right) is shown. Relative RMBF index was defined as RMBF of the infarcted (lateral) wall/RMBF of the normal (septal) wall. At rest, relative RMF index of the BM+Oment group was significantly higher than that of the control group. There was no significant difference between the BM+Oment and the BM group. Under stress, relative RMBF index of the BM group and the BM+Oment group were significantly higher than that in the control group. *p < 0.01 vs the control group. (BM = bone marrow; Oment = omentopexy.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

5. Fig 4
(A) The density of arterioles was evaluated by immunohistochemical staining with anti-alpha-smooth muscle actin antibody (right: BM group, Left: BM+Oment group). (B) The number of arterioles per mm2 were counted (< 50 μm and > 50 μm in diameter). The numbers of arterioles (< 50 μm) were significantly increased in both the BM group and BM+Oment group as compared with the control group. The number of arterioles (> 50 μm) in the BM+Oment group was higher than those of both the BM group and the control group. *p < 0.01 vs the control group and **p = vs the BM group. (BM = bone marrow; Oment = omentopexy.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

6. Fig 5
Representative immunohistochemical fingings in myocardium in BM+Oment group three weeks after injection (original magnification [A] 100×, [B] 400×). A great number of isolated transplanted cells detected with PKH26 red fluorescence cell linker were observed in the myocardium, and some corresponded to capillaries, which were detected with alkaline phosphatase staining. (BM = bone marrow; Oment = omentopexy.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

7. Fig 6
Representative gastroepiploic angiographic findings in BM+Oment group 3 weeks after surgery is shown. Rich collaterals are created from the branches of the left gastroepiploic artery (Lt GEA) in the omental flap to the myocardial capillary beds (small arrow), and retrograde contrast of the coronary artery flow through collaterals is observed (large arrow). (BM = bone marrow; Oment = omentopexy.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

8. Fig 7
Representative postmortem carbon injection test findings in the BM+Oment group. Diluted carbon medium injected from the left gastroepiploic artery was seen filling the arteries of the omental flap and laying within the coronary arterioles in the transmural myocardium. (BM = bone marrow; Oment = omentopexy.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions