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Contrast-echocardiography: confirmation of patency of laser channels after transmyocardial laser revascularization
O Reuthebuch1, K Berwing, M Roth
1Department of Cardio-Vascular Surgery, Unispital Zürich, Zürich, Switzerland. oliver.reuthebuch@chi.usz.ch
Insights
This study provides the first clinical evidence of long-term patency for transmyocardial laser revascularization channels in humans. Echocardiography confirmed perfusion of myocardial channels in 67% of patients, demonstrating long-term channel viability.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Regenerative Medicine
Background:
- Long-term evidence for channel perfusion after transmyocardial laser revascularization (TMLR) in humans is lacking, with current data primarily from autopsy findings.
- TMLR aims to improve myocardial perfusion by creating channels through the left ventricular wall.
Purpose of the Study:
- To provide the first clinical evidence of long-term channel patency following TMLR in human subjects.
- To assess the perfusion and viability of laser-created channels in the myocardium.
Main Methods:
- Fifteen patients undergoing TMLR were investigated using echocardiography.
- Contrast medium was injected into the left ventricular cavity and the left main coronary artery to visualize channel perfusion.
- In some patients, contrast was also injected into bypass grafts.
Main Results:
- In 67% of patients (10 out of 15), one or two laser channels in the apical left ventricular myocardium were successfully visualized.
- Channels demonstrated systolic perfusion, with myocardial opacification extending to a mean width of 1.4 cm, depth of 0.71 cm, and area of 1.0 cm².
- Contrast medium washout occurred via the coronary venous system within an average of 9 systoles.
Conclusions:
- This study presents the first clinical evidence of long-term patency of transmyocardial laser revascularization channels in humans.
- The findings demonstrate that TMLR channels can remain patent and perfused long-term, allowing myocardial opacification via the left ventricular cavity.
Aims:
Apart from casuistic autopsy results there is no long-term evidence for channel perfusion after transmyocardial laser revascularization in humans.
Methods And Results:
Fifteen consecutive patients aged 63+/-17 years were investigated 71+/-15 days after coronary artery bypass surgery and/or transmyocardial revascularization with 13-37 (20+/-5) channels (CO(2) laser, 40 J/pulse). Echocardiography was performed after injection of 6 ml echo contrast medium into left ventricular cavity and after injection of 3 ml contrast medium into the left main coronary artery. In five patients with additional bypass surgery to the same region, we also injected 3 ml contrast medium into bypass graft. We could prove in 10 of 15 patients (67%) one or two laser channels in the apical left ventricular myocardium. Channels were perfused exclusively during systole. During following heart cycles myocardium was opacified up to a mean width of 1.4+/-0.4 cm, a mean depth of 0.71+/-0.1cm, and a mean area of 1.0+/-0.6 cm(2). Contrast medium was washed out via coronary venous system in 9+/-8 systoles.
Conclusion:
This is the first clinical evidence of long-term laser-channel patency in humans showing perfused myocardium via left ventricular cavity.
