By Charles Bridges, Keith Horvath, Ray Chu-Jeng Chiu
Ultimately, there's a in charge consultant to transmyocardial laser revasculariztion (TMR). during this groundbreaking quantity, clinicians who pioneered using this leading edge therapy percentage their insights at the symptoms, effects, mechanisms, and obstacles of the process.
Under the cautious editorial information of Drs. Bridges, Horvath, and Chiu, contributing authors explain:
- the evolution, technological know-how, purpose, and barriers for TMR
- how to choose appropriate candidates
- anesthetic issues and the position of transesophageal echo
- TMR as a sole or blend therapy
Whether you're already working towards TMR or considering its addition for your healing armamentarium, this concise reference will resolution all of your questions on this crucial new procedure.
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Extra resources for Myocardial Laser Revascularization
Long pulses cause collateral thermal damage to tissue adjacent to the ablation crater while short pulses cause collateral mechanical damage. Thermal damage can be the result of thermal diffusion or direct irradiation of tissue at subthreshold levels. Mechanical damage can be the result of explosive vaporization or laser-induced pressure transients. The latter can originate by thermoelastic expansion, ablative recoil, or as a side-effect of rapid explosive vaporization. To a large extent, however, the relevant laser parameters are dictated by the speciﬁc physical properties of the various lasers used and the capabilities of delivery systems rather than by any sort of optimization process of the clinical procedure.
Conversely, scar shrinkage could result in adverse myocardial remodeling; for example, muscle cell disarray similar to that seen in cases of hypertrophic cardiomyopathy has been found adjacent to holmium:YAG-produced ﬁbrosis . Another possible outcome of tissue shrinkage is the likelihood that it could confound interpretation of blood ﬂow measurement within the treated region. The majority of studies that have examined blood ﬂow in patients have used nuclear methods, which involve dividing ventricular cross-sections into segments.
A further caveat should be added because the majority of ablation studies have examined the effect in normal animal hearts. This is potentially important because the energy required to ablate muscle and collagen is different. Theoretically, on this basis, a case could be made for ultraviolet lasers being more effective for ablating the ﬁbrotic myocardial tissue likely to be present in patients requiring TMR. Nevertheless, if open channels are not required in order to achieve clinical beneﬁt, then tissue ablation may be unnecessary.