Transmyocardial laser revascularization.

Abstract

In transmyocardial laser revascularization, a small left thoracotomy incision is made at the fifth rib. The surgeon dissects until adequate exposure of the heart is made, and the laser can be used. The areas to be lasered are identified, and treatment begins. As each laser beam penetrates the myocardium, a flash of bubbles can be seen on echocardiogram exiting the left ventricular outflow tract, which confirms adequate channeling. After revascularization, the mitral valve is inspected for any damage to papillary muscle or leaflets. This case report focuses on a new laser procedure that creates channels in the heart that promote angiogenesis and reestablish blood flow. A 47-year-old man presented for this surgery after having previous coronary artery bypass surgery. He had worsening angina and was not recommended for repeat bypass surgery because of his diffuse disease. Transmyocardial laser revascularization was offered as an alternative to medical therapy. Complications reported include dysrhythmia, bleeding, congestive heart failure, mitral valve damage, low cardiac output syndrome, and death. Many patients note substantial anginal relief after a few weeks. Transmyocardial laser revascularization gives an alternative to those with intractable angina and generally offers an improvement in quality of life.