Angiogenesis and expression of tenascin after transmural laser revascularization

Transmyocardial revascularization (TMR) with CO2-laser equipment is an alternative approach in the treatment of patients with severe ischemic cardiac disease. Several studies concerning morphological features after TMR document a strong transmyocardial injury, but little is known about wound healing in laser-induced alterations of the cardiac skeleton and their putative role for angiogenesis and endothelialization. The present study was conducted to establish a useful immunohistochemical marker for detection of these laser-induced injuries and to analyze starting points of angiogenesis in human myocardium after TMR. Our data show that tenascin labeling is a useful immunohistochemical approach to detect laser-alterated segments of the cardiac skeleton as well as laser-induced fibrosis. Starting points of the angiogenetic process are seen throughout the margins of laser-induced lesions where myocardial capillaries are found. Disrupted vessels located within laser-alterated connective tissue septa are not major starting points for endothelialization of laser-induced lesions and for capillary sprouts. In comparison to laser-induced fibrosis, induction and promotion of angiogenesis by laser radiation is weak.