The stromal stem cell fraction of many tissues and organs has demonstrated to exhibit stem cell properties such as the capability of self-renewal and multipotency, allowing for multilineage differentiation. In this study, we characterize a population of stromal stem cells derived from menstrual blood (MenSCs). We demonstrate that MenSCs are easily expandable to clinical relevance and express multipotent markers such as Oct-4, SSEA-4, and c-kit at the molecular and cellular level. Moreover, we demonstrate the multipotency of MenSCs by directionally differentiating MenSCs into chondrogenic, adipogenic, osteogenic, neurogenic, and cardiogenic cell lineages. These studies demonstrate the plasticity of MenSCs for potential research in regenerative medicine.

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An alternative way to revascularize coronary vessels is described, using arterial conduits without extracorporeal circulation. The heart is exposed via a small thoracotomy over the fifth left intercostal space. A thoracoscope is introduced into the thorax, to assist in the harvesting of the left internal mammary artery (LIMA). In selected patients with two or three vessel disease, the same procedure can be achieved on the right side, harvesting the right internal mammary artery to revascularize the right coronary artery. The gastroepiploic artery can be easily reached and used to revascularize the posterior descending artery, through a mini-subxiphoid median laparotomy. This technique was used to revascularize 30

Several reports have been published recently detailing less invasive techniques for cardiothoracic surgical procedures designed to limit surgical trauma while decreasing costs] After our initial successful experience with minimally invasive video-assisted coronary surgery >4 and minimally invasive video-assisted mitral valve replacement, s which followed the first report of video-assisted mitral valvuloplasty by Carpentier and associates, 6 we performed two cases of minimally invasive aortic valve replacement with a new technique.Clinical summaries PATIENT 1. A 63-year-old male patient was admitted in July 1996 with severe calcific aortic stenosis, chronic obstructive pulmonary artery disease, and New York Heart Association class IV symptoms. The patient was placed on the operative table in the 30-degree left lateral decubitus position with the right arm elevated above the head. A 6 cm incision was made in the third intercostal space (Fig. 1), and a specially adapted wound spreader (Access Platform, CardioThoracic System, Inc., Portola Valley, Calif.) was secured in place and gently opened to avoid rib fractures. The pericardium was opened on the lateral side exposing the aortic root, the right atrium, and the right superior pulmonary vein (RSPV). To improve the exposure, we supplied several stay sutures at the edges of the pericardial opening and fixed them to the skin. The right femoral artery and the right atrium were cannulated. A vent was inserted in the RSPV. After cardiopulmonary bypass (CPB) was established, the aorta was crossclamped and crystalloid cardioplegic solution was infused in the aortic root. A transverse aortotomy was performed and three stitches were placed in the commissures and pulled upward to expose the anulus. A 21 mm mechanical prosthesis was implanted with single Cardioflon sutures (Peters Laboratories, France). The aortotomy was then closed with a polypropylene running suture, and the air was evacuated through the aortic root and the RSPV vent. Perfusion time was 85 minutes and crossclamp time was 70 minutes. The patient was extubated 24 hours after the operation and discharged on postoperative day 6. The postoperative course was uneventful.PATIENT 2. A 52-year-old male patient was admitted in July 1996 with severe aortic regurgitation and New York Heart Association class IV symptoms. The patient was

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