Use of Magnetic Resonance Imaging to Assess Myocardial Perfusion after Transmyocardial Laser Revascularization

Authors

  • Mehmet H. Akay
  • Benjamin Y. Cheong
  • O. H. Frazier

DOI:

https://doi.org/10.1532/HSF98.20081090

Abstract

Background: Transmyocardial laser revascularization (TMLR) is an alternative treatment modality for patients with refractory angina who are not candidates for conventional surgical or percutaneous revascularization. Clinical studies of TMLR have not shown one-to-one correlation between increased myocardial perfusion and improved clinical status.

Methods: Three patients (51, 53, and 70 years old) with severe, diffuse coronary artery disease not amenable to conventional surgical revascularization and with angina (Canadian Cardiovascular Society [CCS] class 3-4) refractory to maximal medical therapy underwent TMLR with a CO2 laser. Preoperative and postoperative cardiac magnetic resonance imaging (MRI) were performed to assess left ventricular perfusion and wall-motion changes in the laser-treated areas. Postoperative MRIs were performed within 6 months of TMLR and at 12 months. Angina status was assessed with the Seattle Angina Questionnaire.

Results: Postoperative adenosine stress myocardial perfusion imaging with MRI revealed improved overall perfusion and a reduction in subendocardial hypoperfused areas when compared to preoperative images. In all patients, an improvement in CCS class was consistent with an improvement in perfusion.

Conclusions: Cardiac MRI can be used to assess improved subendocardial perfusion after TMLR treatment. In our study, we found that endocardial perfusion was maintained over a 12-month period.

References

Allen KB, Dowling RB, Fudge TL, et al. 1999. Comparison of transmyocardial revascularization with medical therapy in patients with refractory angina. N Engl J Med 341:1029-36.nAllen KB, Dowling RD, Heimansohn DA, et al. 2003. Transmyocardial revascularization versus medical therapy: five-year follow-up of a prospective randomized trial. Heart Surg Forum 6(Supp 1):S15.nFrazier OH, Cooley DA, Kadipasaoglu KA, et al. 1995. Myocardial revascularization with laser: preliminary findings. Circulation 92(9 Suppl):II58-65.nFrazier OH, March RJ, Horvath KA. 1999. Transmyocardial revascularization with a carbon dioxide laser in patients with end-stage coronary artery disease. N Engl J Med 341:1021-8.nGebker R, Schwitter, Fleck E, Nagel E. 2007. How we perform myocardial perfusion with cardiovascular magnetic resonance. J Cardiovasc Magn Reson 9:539-47.nHattler BG, Griffith BP, Zenati MA, et al. 1999. Transmyocardial laser revascularization in the patient with unmanageable unstable angina. Ann Thorac Surg 68:1203-9.nHorvath KA, Cohn LH, Cooley DA, et al. 1997. Transmyocardial laser revascularization: results of a multicenter trial with transmyocardial laser revascularization used as sole therapy for end-stage coronary artery disease. J Thorac Cardiovasc Surg 113:645-54.nHorvath KA, Aranki SF, Cohn LH, et al. 2001. Sustained angina relief 5 years after transmyocardial laser revascularization with a CO(2) laser. Circulation 104(12 Suppl 1):I81-4.nKadipasaoglu KA, Frazier OH. 1999. Transmyocardial laser revascularization: effect of laser parameters on tissue ablation and cardiac perfusion. Semin Thorac Cardiovasc Surg 11:4-11.nKwong KF, Schuessler RB, Kanellopoulos GK, Saffitz JE, Sundt TM 3rd. 1998. Nontransmural laser treatment incompletely denervates canine myocardium. Circulation 98(19 Suppl):II67-72.nMartin ET, Fuisz AR, Pohost GM. 1998. Imaging cardiac structure and pump function. Cardiol Clin 16:135-60.nOkada M, Ikuta H, Shimizu K, Horii H, Nakamura K. 1986. Alternative method of myocardial revascularization by laser: experimental and clinical study. Kobe J Med Sci 32:151-61.nRimoldi O, Burns SM, Rosen SD, et al. 1999. Measurement of myocardial blood flow with positron emission tomography before and after transmyocardial laser revascularization. Circulation 100(19 Suppl):II134-8.nSchofield PM, Sharples LD, Caine N, et al. 1999. Transmyocardial laser revascularisation in patients with refractory angina: a randomised controlled trial. Lancet 353::519-24.nSchwitter J. 2006. Myocardial Perfusion. J Magn Reson Imaging 24:953-63.nSpanier T, Smith CR, Burkhoff D. 1997. Angiogenesis: a possible mechanism underlying the clinical benefits of transmyocardial laser revascularization. J Clin Laser Med Surg 15:269-73.nvan der Sloot JA, Huikeshoven M, Tukkie R, et al. 2004. Transmyocardial revascularization using an XeCl excimer laser: results of a randomized trial. Ann Thorac Surg 78:875-81.nWilke N, Jerosch-Herold M. 1998. Assessing myocardial perfusion in coronary artery disease with magnetic resonance first-pass imaging. Cardiol Clin 16:227-46.n

Published

2009-08-14

How to Cite

Akay, M. H., Cheong, B. Y., & Frazier, O. H. (2009). Use of Magnetic Resonance Imaging to Assess Myocardial Perfusion after Transmyocardial Laser Revascularization. The Heart Surgery Forum, 12(4), E199-E201. https://doi.org/10.1532/HSF98.20081090

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Section

Articles