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(Circulation. 2001;103:469.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Histological Evidence of Angiogenesis 9 Months After Transmyocardial Laser Revascularization

Patrick W. Domkowski, MD, PhD; Shankha S. Biswas, MD; Charles Steenbergen, MD, PhD; James E. Lowe, MD

From the Departments of Surgery and Pathology, Duke University Medical Center, Durham, NC.

Correspondence to James E. Lowe, MD, Professor of Surgery, Department of Surgery, Duke University Medical Center, Box 3954, Durham, NC 27710.

A 66-year-old white male with end-stage ischemic cardiomyopathy was referred to our center for transmyocardial laser revascularization (PLC Eclipse Surgical Technologies) in July 1999. The patient had a long history of interventions for his coronary artery disease, including multiple percutaneous transluminal coronary angioplasties, stent placement in 1991 and 1993, and coronary artery bypass grafting in 1987 and 1992. He was evaluated for a third bypass, but we determined he was not a suitable candidate because of his diffuse small vessel distal coronary artery disease. Given the limitations of conventional therapeutic options, the patient underwent transmyocardial laser revascularization in July 1999. Thirty transmural channels were lased in the ischemic anterior and lateral walls of the left ventricle. The patient tolerated the procedure well and received anginal relief for the following 6 months; he then experienced recurrent symptoms of angina and progressive cardiac failure. Stress thallium²⁰¹ imaging at that time demonstrated increased ischemic areas in the posterior and inferior myocardium, with improved perfusion in the previously lased anterior and lateral walls. His clinical situation continued to deteriorate, and he was listed for and subsequently received a heart transplant in March 2000. At that time, his native heart was explanted and examined for evidence of angiogenesis in the lased areas of myocardium.

Gross inspection of cross-sections of the explanted heart revealed visible scar tissue in the inferior and posterolateral areas, consistent with old myocardial infarctions; however, no grossly visible scar tissue was evident in the anterolateral lased wall of the left ventricle, either . . . [Full Text of this Article]

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