Lasers in the treatment of ischaemic heart disease

Abstract

Mounting evidence showing that transmyocardial laser revascularization (TMR) is a safe and effective treatment for angina pectoris arrives just as an increasing number of patients who have undergone angioplasty and coronary artery bypass grafting experience failure with time. TMR, nevertheless, remains controversial. It appears to relieve the symptoms without treating the underlying atherosclerotic disease, and its method of action is unproven. Like angioplasty and coronary bypass, TMR in fact offers palliation rather than a cure for atherosclerotic heart disease. The most sensible current formulations of the therapeutic mechanism of TMR posit a reconfiguration of the microcirculation, with blood shunted from epicardial to endocardial areas. These unresolved issues notwithstanding, TMR benefits patients with end-stage coronary disease and represents a pioneering effort to remodel the microcirculation of patients with arteriosclerotic occlusive disease.

Transmyocardial Laser Revascularization

“…[43] Although little information could be derived about efficacy because of the concomitant bypass procedure, this pivotal study provided reassurance about the safety of TMR procedure which permitted other studies to be performed. [57,[62][63][64][65][66][67][68][69][70] Beginning with the early published results of Cooley et al [46] and Frazier et al, [49] reports of clinical studies have uniformly shown significant improvements in angina pectoris as indexed by Canadian Cardiovascular Society Angina (CCSA) scores, regardless of the laser system used. [44,[58][59][60][61] In the randomized studies, patients with medically refractory angina pectoris not suitable for revascularization were treated with surgical TMR plus continued optimal medications or with continued medical therapy alone.…”

Simulations of temperature field induced by laser in biological tissue

“…It is proved that laser hyperthermia combining with radiation therapy or chemotherapy can improve the curative effect significantly. Due to the development of laser equipment, laser hyperthermia is widely used in clinic now 4,5,6 . As the difference in the damage between normal and abnormal tissue disappears at high temperature, the distribution of temperature will influence the curative effect and the security of patients directly in the course of laser treatment.…”