Clinical report: Laser myocardial revascularization

Abstract

A significant number of patients with ischemic heart disease are not candidates for coronary artery bypass or percutaneous transluminal angioplasty and do not respond to medical management. This group includes those who have diffuse coronary artery disease, those with poor ventricular function, and those who have had poor results from previous surgery. Developing a method to directly revascularize the myocardium by creating channels through the ventricular wall has challenged many investigators. Early methods, including needle acupuncture, were successful in the acute phase, but long-term patency could not be achieved. Closure of the channels was due to fibrosis and scarring. Experiments in our laboratory demonstrated that myocardial channels, made with the CO2 laser, remained patent up to five years. Histopathologic examination of the channels showed minimal damage to the surrounding cells in the acute phase. Studies at intervals of two months to two years showed patent endothelialized channels, with no evidence of fibrosis. Channels created in the myocardium protected the ventricle against an ischemic event when the left anterior descending branch of the coronary artery was ligated. Clinical experience with direct myocardial revascularization by CO2 laser indicates it may be a viable method of treating those patients with ischemic heart disease who are not candidates for other forms of management. The treatment and early postoperative follow-up in one patient are described.

Transmyocardial Laser Revascularization: Established Procedure, Acupuncture of the Heart or Placebo Effect?

“…1). The first clinical results were published in1986 by Mirhoseini et al [3]. Since that time, TMLR has been applied worldwide in several thousand patients.…”

“…Since the first report from Mirhoseini et al [3], numerous studies have been published which have dealt with the isolated laser application or the combined procedure (table 1). In coronary heart disease with symptoms refractory to conventional treatment, TMLR causes a reduction of the angina class symptomatology in many cases.…”

Long-Term Results of Transmyocardial Laser Revascularization Combined With Implantation of Autologous Bone Marrow Mononuclear Fraction in the Treatment of Chronic Ischemic Heart Diseas

“…Каналы, со-здаваемые с помощью лазера, остаются открыты-ми и могут перфузировать миокард, защищая от ишемии, и являются надежными резервуарами для МФАКМ. Первые гистологические данные о про-ходимости каналов представил M. Mirhoseini [4,5]. Он и его коллеги сообщили об оставшихся откры-тыми в течение двух лет после операции каналах.…”

Bone marrow mononuclear cell implantation in myocardial laser channels in the ischemic heart disease surgery. Long-term results

“…Channels created by laser remain open and perfused myocardium protects against ischemia, and these are reliable reservoirs for BMC. The first histological data on the cross-channel were introduced by Mirhoseini [4,5]. He and his colleagues reported on channels remaining open within two years after the operation.…”