Abstract
The use of lasers to create transmyocardial channels in hibernating myocardium is being considered as an alternative for patients who cannot be treated with ordinary bypass surgery. The physiological mechanism behind the therapy is not yet understood and is still hard to prove in studies. Although the idea of transmyocardial revascularisation (TMR) started with the perfusion concept of a reptile heart [1], the functioning might also be ascribed to neoplastic revascularisation of the hibernating myocardium [2]. At the basis of the biological response is the creation mechanism of the channel. Therefore, it is beneficial to study and understand the working mechanism of the creation of channels by the various lasers currently being use [3]. With this knowledge it is possible to control the characteristics of the channels, depending on the laser parameters. Based on earlier experience [4], it is believed that the channels for transmyocardial laser recanalisation (TMLR) should meet the following conditions: the channels for ‘reperfusion’ should be about 15–25 mm long and 1 mm in diameter. For minimal invasive treatment, the channels should be created on a beating heart within the diastolic phase (<100 ms) or on an arrested heart using multiple pulses. Long-term patency is expected when the walls of the channels have minimal thermal damage.
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Verdaasdonk, R., Sachinopoulou, A., Gründeman, P., Beek, J. (1998). Working Mechanism of Pulsed CO2/ Holmium and Excimer Laser Systems with Regard to Transmyocardial Revascularisation (TMR): In Vivo Implications. In: Klein, M., Schulte, H.D., Gams, E. (eds) TMLR Management of Coronary Artery Diseases. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-72134-2_12
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DOI: https://doi.org/10.1007/978-3-642-72134-2_12
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