Use of Laser in Cardiology TRANSMYOCARDIAL LASER REVASCULARIZATION (TMR)

Presented by

Maryam Liaqat

Topics of discussion

Laser Medicine

Types of Laser

History of Transmyocardial laser revascularization

TMR

Carbon Dioxide Laser

Method of TMR

Future of TMR

Advantages of TMR

Breath new Life of Myocardium

Laser medicine

Laser is used for different purposes in medical field like

Medical diagnosis

Medical therapies

Medical surgery

Transmyocardial Laser Revascularization (TMR)

Endovascular surgery

Eye surgery

Foot and Ankle surgery

Important lasers use in medical application are

Argon laser

Carbon Dioxide

Eximer Laser

Ho:YAG Laser

Nd:YAG Laser

History of TMR

Arthur Vineberg in 1964 attempted to improve myocardial blood flow by tunneling the left internal mammary artery directly into the left ventricular myocardium

TMR is a derivative of older procedures developed before CABG surgery to augment coronary blood flow

First time it introduced in 1990’s when the Coronary Artery Bypass Surgrey (CABS) couldn’t work for patients due to some other diseases to reduce Angina pain

Pelletier MP, et al. Ann Thorac Surg. 1998;66:12–18

Transmyocardial Laser Revascularization

Angina is heart disease when lower left ventriclemuscles of heart doesn’t recieve oxygenated bloodtherefore increase the risk of heart attack andcause painful condtion

Laser drilled small holes from ventricle intomyocandium allowing blood to flow directly intothe heart muscle without the need to travelthrough blocked coronary arteries

Transmyocardial Laser Revascularization

Invasive heart surgery

Create open channels using laser (Carbon Dioxide)

Drill 10 -30 holes in about 5 minutes

Channel of 1mm diameter and 1cm apart from each other

Carbon dioxide is high power laser (800-1000W/mm2)

Energy of each laser pulse was lo-60 J

Pulse duration of lo-50 ms

Laser pulses induced during heart beats **N. Gassler and Hans-Martin in 1997 Clinical data and histological

features of transmyocardial revascularization with CO,-laser ’

Carbon Dioxide Laser

Has highest-power continuous wave laser

CO2 laser produced a beam of infrared light spot size of 9.4 and 10.6micrometer

Pulse rate is 100 microsecond

CO2 laser consists of a gas discharge with a total reflector at one end, and an output coupler at the output end

Power of CO2 laser is from milliwatts (mW) to hundreds of kilowatts (kW)

Wavelength of carbon dioxide is 1 cm−1 (30 GHz)

Gas within the discharge tube consists of around 10–20% CO2

around 10–20% Nitrogen

Few percent of Hydrogen and

Xenon or Helium

Laser Revacularization Method

https://www.youtube.com/watch?v=fXG4WystbUg

https://www.youtube.com/watch?v=4TtOLrsp5uo

Advantages of TMR

Immidiate improvment

Long term relife

Better quality of life

Totaly elimated the effect of Angina

150% improvement reported in angina patients after TMR

Only 2% patients of TMR are hospitalized after 1 year whereas

other treatmenst like CABS etc 69% patients are addmitted

Future of TMR

Angiogenesis is produced with TMR which is creation of a controlled injury to the myocardium that is natural wound-healing response.

Carbo Dioxide and mesenchymal stem cells from bone marrow injected for Angiogensis

**G.Reyes et al.,(2009) Bone Marrow LR for treating refractory angina due to diffusion coronary heart disease

Thanks for attention