A histologic study of laser-induced transmyocardial channels

Carbon dioxide lasers are reported to provide ischemic myocardium direct access to blood within the ventricular cavity by inducing transmyocardial channels which maintain patency in long-term experiments. We have histologically examined the natural history of channels produced with this technique and compared them with transmyocardial channels created by needle puncture. Immediately after application of the laser, four concentric zones vaporization, carbonization, fixation, and transition could be distinguished along the transmyocardial path. Needle puncture channels were fully occluded within 48 hr, whereas laser-induced channels maintained partial patency for a 2-week period, after which they also became occluded. It appears likely that the instantaneous vaporization produced by the laser may delay the release of factors which mediate the healing process, but occlusion of channels was universal in this study. It remains to be determined whether or not variables such as wattage, beam diameter, or tissue temperature influence long-term channel patency.