Abstract
Aim: To analyse the clinical outcome and myocardial perfusion and function after transmyocardial revascularisation (TMR) in patients with normal left ventricular function and multivessel coronary artery disease non-amenable for standard revascularisation. Method and results: Twenty three severely symptomatic patients (CCS score median 4) with normal left ventricular systolic function but coronaries non-amenable for either PTCA or CABG were subjected to TMR. The angina score, left ventricular systolic and diastolic function in radionuclide ventriculography at rest, exercise tolerance and myocardial perfusion – Thallium-201 SPECT (adenosine stress 74 and 37 MBq under nitrate cover) were evaluated before and 3, 6, 12 months post-operatively. After an average of 40 ± 12 (range 14–56) TMR channels angina score decreased significantly (p< 0.0001) and the exercise tolerance increased (from 6.0 ± 4.5 to 9.1 ± 4.6 after 6 months, p< 0.05) in 21 patients. During the follow up period two patients had a myocardial infarction and one committed suicide after 6 months. Ejection fraction dropped significantly only after 1 year post-TMR from 70 ± 13 to 63 ± 0.13%, p < 0.05. The overall perfusion improved initially in 14 patients with subsequent deterioration in time. The changes in segmental perfusion were not associated with the symptomatic improvement. Conclusion: Transmyocardial revascularisation in patients with normal ejection fraction may improve the angina class, exercise tolerance and overall but not segmental perfusion and does not show any immediate effect on left ventricular function.
Similar content being viewed by others
References
DA Cooley OH Frazier KA Kadipasoglu et al. (1994) ArticleTitleTransmyocardial laser revascularization: anatomic evidence of long term patency Tex Heart Inst J 21 220–224 Occurrence Handle8000270
M Saririan MJ Eisenberg (2003) ArticleTitleMyocardial laser revascularization for the treatment of end-stage coronary artery disease J Am Coll Cardiol 41 173–183 Occurrence Handle12535804
M Salem S Rotevatn S Stavnes M Brekke SE Vollset JE Nordrehaug (2004) ArticleTitleUsefulness and safety of percutaneous myocardial laser revascularization for refractory angina pectoris Am J Cardiol 93 IssueID9 1086–1091 Occurrence Handle15110197
GW Stone PS Teirstein R Rubenstein et al. (2002) ArticleTitleA prospective multicenter randomised trial of a percutaneous transmyocardial laser revascularization in patients with nonrecanalizable chronic total occlusion J Am Coll Cardiol 39 1581–1587 Occurrence Handle12020483
DA Cooley DH Frazier KA Kadipasaoglu (1996) ArticleTitleTransmyocardial laser revascularization: clinical experience with twelve-month follow-up J Thorac Cardiovasc Surg 111 791–799 Occurrence Handle8614139
OH Frazier RJ March KA Horvarth (1999) ArticleTitleTransmyocardial revascularization with a carbon dioxide laser in patients with end-stage coronary artery disease N Engl J Med 341 IssueID14 1021–1028 Occurrence Handle10502591
AK Horvath F Mannting N Cummings SK Shernan LH Cohn (1996) ArticleTitleTransmyocardial laser revascularisation: operative techniques and clinical results at two years J Thorac Cardiovasc Surg 111 1047–1053 Occurrence Handle8622302
H Nagele H Stubbe C Nienaber W Rodiger (1998) ArticleTitleResults of transmyocardial laser revascularization in non-revascularisable coronary artery after 3 years of follow-up Eur heart J 19 1525–1530 Occurrence Handle9820991
R Agarval M Ajit VM Kurian et al. (1999) ArticleTitleTransmyocardial laser revascularisation: early results and 1-year follow-up Ann Thorac Surg 67 IssueID2 432–436 Occurrence Handle10197665
D Burkhoff S Schmidt SP Schulman et al. (1999) ArticleTitleTransmyocardial laser revascularisation compared with continued medical therapy for treatment of refractory angina pectoris: a prospective randomised trial Lancet 354 885–890 Occurrence Handle10489946
PM Schofield LD Sharples N Caine et al. (1999) ArticleTitleTransmyocardial laser revascularization in patients with refractory angina: a randomised controlled trial Lancet 353 519–524 Occurrence Handle10028979
KF Kwong RB Schuessler GK Kanellopoulos et al. (1998) ArticleTitleNon-transmural laser treatment incompletely denervates canine myocardium Circulation 98 IssueIDSuppl. II 67–71
SM Burns LD Sharples S Tait et al. (1999) ArticleTitleThe transmyocardial laser revascularisation: international registry report Eur Heart J 201 31–37
FA Shawl MJ Domanski U Kau et al. (1999) ArticleTitleProcedural results and early clinical out come of percutaneous transluminal myocardial revascularisation Am J Cardiol 83 498–501 Occurrence Handle10073850
I Morgan C Campabella (1998) ArticleTitleTransmyocardial laser revascularization in Edinburgh Br J Theatre Nurs 7 4–9 Occurrence Handle9543926
F Memon M Moinuddin S Queshi et al. (1998) ArticleTitleEarly experience with transmyocardial laser revascularisation JPMA 48 329–331
KA Horvath LH Cohn DA Cooley et al. (1997) ArticleTitleTransmyocardial laser revascularization: results of multicenter trial with transmyocardial laser revascularisation used as a sole therapy for end-stage coronary artery disease J Thorac Cardiovasc Surg 113 645–654 Occurrence Handle9104973
RJ March (1999) ArticleTitleTransmyocardial laser revascularisation with the CO2 laser: one year results of a randomised controlled trial Semin Thorac Cardiovasc Surg 11 12–18
CL Donovan KP Landolfo JE Lowe et al. (1997) ArticleTitleImprovement in inducible ischemia during dobutamine stress echocardiography after transmyocardial laser revascualrisation in patients with refractory angina pectoris J Am Coll Cardiol 30 607–612 Occurrence Handle9283515
R Kluge B Lauer F Stahl et al. (2000) ArticleTitleChanges in myocardial perfusion after catheter-based percutaneous laser revascularization Eur J Nucl Med 27 1292–1299 Occurrence Handle11007509
A Milano S Pratali G Tartarini et al. (1998) ArticleTitleEarly results of transmyocardial revascualrization with a holmium laser Ann Thorac Surg 65 700–704 Occurrence Handle9527198
SM Burns S Brown CA White et al. (2001) ArticleTitleQuantitive analysis of myocardial perfusion changes with transmyocardial laser revascularization Am J Cardiol 87 IssueID7 861–867 Occurrence Handle11274941
KA Horvath WJ Smith RG Laurence et al. (1995) ArticleTitleRecovery and viability of an acute myocardial infarct after transmyocardial laser revascularisation J Am Coll Cardiol 25 258–263 Occurrence Handle7798512
D Burkhoff PE Fisher M Apfelbaum et al. (1996) ArticleTitleHistologic apperance of transmyocardial laser channels after 4 weeks Ann Thorac Surg 61 1532–1535 Occurrence Handle8633979
PE Fischer T Khomoto CM DeRosa et al. (1997) ArticleTitleHistologic analysis of transmyocardial channels: comparison of CO2 and holmium: YAG lasers Ann Thorac Surg 64 466–472 Occurrence Handle9262595
N Gassler HO Wintzer HM Stubbe et al. (1997) ArticleTitleTransmyocardial laser revascularisation. histological features in human non-responder myocardium Circulation 95 371–375 Occurrence Handle9008451
R Landrenau W Nawarong H Laugfhlin et al. (1991) ArticleTitleDirect CO2 laser ‘revascularization’ of the myocardium Laser Surg Med 11 35–42
RI Hardy FW James RW Millard S Kaplan (1990) ArticleTitleRegional myocardial blood flow and cardiac mechanics in dog hearts with CO2 laser induced intramyocardial revascualrisation Basic Res Cardiol 85 179–197 Occurrence Handle2350332
T Al-Sheikh KB Allen SP Straka et al. (1999) ArticleTitleCardiac sympathetic denervation after transmyocardial laser revascularization Circulation 100 135–140 Occurrence Handle10402442
D Burkhoff JW Jones LC Becker (2001) ArticleTitleVariability of myocardial perfusion defects assessed by thallium-201 scintigraphy in patients with coronary artery disease not amenable to angioplasty or bypass surgery J Am Coll Cardiol 38 1033–1039 Occurrence Handle11583878
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dziuk, M.A., Canizales, A., Ali, N. et al. The prospective clinical and scintigraphic assessment of patients with preserved left ventricular systolic function after transmyocardial laser revascularisation. Int J Cardiovasc Imaging 21, 405–412 (2005). https://doi.org/10.1007/s10554-004-7987-x
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s10554-004-7987-x