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(Circulation. 1998;98:728-729.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Improvement of Myocardial Perfusion After Transmyocardial Laser Revascularization and Coronary Artery Bypass Graft Surgery

Ami E. Iskandrian, MD; James D. Sink, MD; ; William VanDecker, MD

From Allegheny University of the Health Sciences, MCP–Hahnemann School of Medicine, Philadelphia, Pa.

A69 -year-old man with severe angina had severe 3-vessel disease by coronary angiography. At the time of coronary revascularization, he had left internal mammary artery implantation to the left anterior descending artery, a vein graft to the diagonal branch, and a vein graft to the marginal branch of the left circumflex artery. Transmyocardial laser revascularization was performed in the territory of the right coronary artery (because of poor distal runoff) with a xenon chloride excimer laser (under an investigational device exemption sponsored by United States Surgical Corp). The postoperative course was uneventful. The patient experienced improvement of symptoms.

The patient had an exercise treadmill test by the Bruce protocol before and 3 months after surgery. Before surgery, he developed angina during exercise with ST-segment depression at 75% of maximum predicted heart rate. After surgery, he exercised to 87% of maximum predicted heart rate with no angina or ST-segment depression.

Before surgery, exercise single photon emission CT (SPECT) ^99mTc-sestamibi myocardial images revealed extensive reversible perfusion defects consistent with 3-vessel ischemia. After surgery, the exercise SPECT perfusion images were almost normal (Figure). The improvement in the perfusion pattern during exercise was equally remarkable in the vascular area treated with laser and the vascular territories treated with bypass surgery.

View larger version (85K): [in this window] [in a new window]   Figure 1. Exercise 99mTc-sestamibi images obtained before (upper row) and after (lower row) surgery. Top left panel, Short-axis slices; middle left panel, vertical long-axis slices; top right panel, horizontal long-axis slices. Polar maps are shown in right middle panel (before surgery, left; after surgery, right). Gated three-dimensional perfusion images at end diastole (left) and end systole (right) before surgery are shown in the left lower panel and after surgery in the lower right panel. Preoperative images reveal extensive perfusion defects involving the 3 vascular territories. Rest images (not shown) reveal almost complete redistribution. Postoperative images reveal almost complete normalization of perfusion pattern. Of note, improvement in perfusion pattern in territory of right coronary artery (area of transmyocardial laser revascularization) is comparable to improvement in territories of left anterior descending and left circumflex coronary arteries (areas revascularized with bypass grafting).

Footnotes

Reprint requests to Ami E. Iskandrian, MD, William Penn Snyder III Professor of Medicine, Director, Cardiovascular Research Center, Allegheny University of the Health Sciences, MCP–Hahnemann School of Medicine, Division of Cardiology, Department of Medicine, and Division of Cardiothoracic Surgery, 230 N Broad St, Philadelphia, PA 19102.

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.

This article has been cited by other articles:

				A. M. Calafiore Myocardial Perfusion After Transmyocardial Laser Revascularization Circulation, December 14, 1999; 100 (24): e117 - e117. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Iskandrian, A. E. Articles by VanDecker, W. Search for Related Content PubMed PubMed Citation Articles by Iskandrian, A. E. Articles by VanDecker, W. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Coronary Artery Bypass Surgery Nuclear Scans