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Cellular destruction following transmyocardial laser revascularization (TMR)
S M Cherian1, Y V Bobryshev, D Tran
1Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, TN, 600050, India.
Abstract:
During transmyocardial revascularization, cellular destruction of cardiomyocytes occurs as a result of the high-energy laser. However, the features of myocardial cellular destruction are unclear. The present study was undertaken to examine the structural characteristics of cell death in the myocardium following transmyocardial revascularization. Myocardial specimens from 3 male patients who had died within 11 days following laser revascularization were collected within 1 h of death and were analyzed by immunohistochemistry and electron microscopy. For immunohistochemistry, antibodies to pro-apoptotic proteins CPP32 and BAX were used. Immunohistochemical examination demonstrated the presence of cells expressing both CPP32 and BAX along the laser channel. Electron microscopic analysis revealed that the lining surface of laser channels consisted of condensed acellular debris and dead cells. No endothelialization of channels was noted. The lumen of laser channels were surrounded by a rim of acellular debris with several outer concentric rims of cardiomyocytes showing features of cellular destruction. The present study identified features of both necrotic and apoptotic cellular death following laser revascularization.
Insights
Transmyocardial revascularization causes cardiomyocyte death, with both necrotic and apoptotic features observed along laser channels. This study clarifies the structural characteristics of cell death following this cardiac procedure.
Area of Science:
- Cardiovascular Surgery
- Cell Biology
- Pathology
Background:
- Transmyocardial revascularization (TMR) utilizes high-energy lasers to create channels in the myocardium.
- The precise mechanisms and structural features of cardiomyocyte (heart muscle cell) destruction during TMR remain incompletely understood.
Purpose of the Study:
- To investigate the structural characteristics of myocardial cellular death after transmyocardial revascularization.
- To identify the types of cell death (apoptosis vs. necrosis) occurring in cardiomyocytes adjacent to laser channels.
Main Methods:
- Analysis of myocardial tissue from three male patients within 11 days post-TMR.
- Utilized immunohistochemistry with antibodies against pro-apoptotic proteins CPP32 and BAX.
- Employed electron microscopy to examine the ultrastructure of laser channels and surrounding cardiomyocytes.
Main Results:
- Immunohistochemistry revealed cells expressing CPP32 and BAX along the laser channels, indicating apoptosis.
- Electron microscopy showed laser channels lined with acellular debris and dead cells, lacking endothelialization.
- Surrounding cardiomyocytes exhibited features consistent with both necrotic and apoptotic cell death.
Conclusions:
- Transmyocardial revascularization induces both apoptotic and necrotic cell death in cardiomyocytes.
- The laser channels are characterized by cellular debris and dead cells, without evidence of new blood vessel formation (endothelialization).
- Understanding these cell death pathways is crucial for evaluating TMR efficacy and safety.
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