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. Author manuscript; available in PMC: 2021 Jun 1.
Published in final edited form as: Nat Rev Cardiol. 2021 Jan 26;18(6):389–399. doi: 10.1038/s41569-020-00499-9

Fig. 2 |. Delivery methods targeting the heart.

Fig. 2 |

The therapeutic agent is depicted in green. a | Surgical approaches. (1) A cell sheet, tissue strip or biomaterial patch is about to be applied to a diseased area of the myocardium, such as an infarcted region (purple). (2) An epicardial injection is applied to the border zone of the diseased area. (3) Painting is applied on the right atrium. (4) Using cardiopulmonary bypass, retrograde recirculation via the coronary sinus allows cardiac-targeted delivery. b | Catheter-based approaches. (5) The coronary arteries are accessed using a guidewire and a guiding catheter (light blue), and coronary balloon occlusion is incorporated to facilitate transduction of the therapeutic agent. (6) The coronary sinus is selected using a guidewire and a balloon catheter (light blue), and the therapeutic agent is injected retrogradely in a coronary vein. (7) Transvalvular endocardial injection from the left ventricle. (8) Pericardial injection is administered using a percutaneous access sheath and an injection catheter (light blue).