P Whittaker1, K Spariosu, Z Z Ho. 1. Heart Institute, Good Samaritan Hospital, and Department of Medicine, University of Southern California, Los Angeles 90017, USA.
Abstract
BACKGROUND AND OBJECTIVE: Previous studies of transmyocardial laser revascularization have reported open channels after ultraviolet laser treatment and closed channels with infrared lasers. We speculated that differences in long-term channel patency were determined by the healing response to injury. METHODS: Channels were made in rat hearts with a frequency-tripled neodymium:YAG laser, at 5 and 10 mJ per pulse, by advancing an optic fiber through the myocardium, from the epicardium to the ventricular cavity. Several months later, we challenged the ability of the channel to supply blood by arterial occlusion and examined the channel structure with polarized light microscopy. RESULTS: Low-pulse energy was associated with lower patency, more fibrosis, and larger infarcts than was the higher energy. Open channels were surrounded by collagen fibers aligned parallel to the channel; in closed channels, fibers were aligned perpendicular to the original channel direction. CONCLUSION: The amount of initial injury and its repair determine channel patency and function.
BACKGROUND AND OBJECTIVE: Previous studies of transmyocardial laser revascularization have reported open channels after ultraviolet laser treatment and closed channels with infrared lasers. We speculated that differences in long-term channel patency were determined by the healing response to injury. METHODS: Channels were made in rat hearts with a frequency-tripled neodymium:YAG laser, at 5 and 10 mJ per pulse, by advancing an optic fiber through the myocardium, from the epicardium to the ventricular cavity. Several months later, we challenged the ability of the channel to supply blood by arterial occlusion and examined the channel structure with polarized light microscopy. RESULTS: Low-pulse energy was associated with lower patency, more fibrosis, and larger infarcts than was the higher energy. Open channels were surrounded by collagen fibers aligned parallel to the channel; in closed channels, fibers were aligned perpendicular to the original channel direction. CONCLUSION: The amount of initial injury and its repair determine channel patency and function.