J.E. Sigel, MD, C.M. Abramovich, MD, B.W. Lytle, MD, N.B. Ratliff, MD

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Presentation transcript:

Transmyocardial laser revascularization: Three sequential autopsy cases J.E. Sigel, MD, C.M. Abramovich, MD, B.W. Lytle, MD, N.B. Ratliff, MD The Journal of Thoracic and Cardiovascular Surgery Volume 115, Issue 6, Pages 1381-1385 (June 1998) DOI: 10.1016/S0022-5223(98)70225-9 Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 1 This laser channel from the acute postoperative phase demonstrates sharp, well-demarcated borders surrounded by a thin zone of thermal-induced char and coagulated protein. The lumen of the channel is filled with coagulated protein, blood, and acute inflammatory cells. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 1381-1385DOI: (10.1016/S0022-5223(98)70225-9) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 2 This laser channel from the acute postoperative phase demonstrates a zone of acute inflammation and necrotic myocytes in the immediately adjacent myocardium. As in Fig. 1, the lumen is filled with coagulated protein, blood, and acute inflammatory cells. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 1381-1385DOI: (10.1016/S0022-5223(98)70225-9) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 3 Collateral damage in the acute postoperative phase included a narrow cuff of necrotic subepicardial myocytes surrounding the entrance of a single laser channel into the myocardium. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 1381-1385DOI: (10.1016/S0022-5223(98)70225-9) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 4 This laser channel from 10 days after the operation demonstrates sharp, well-demarcated borders. The lumen of the channel is filled with fibroblasts, macrophages, multinucleated foreign-body giant cells, and small blood vessels. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 1381-1385DOI: (10.1016/S0022-5223(98)70225-9) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 5 Ten days after the operation, this small atherosclerotic intramyocardial coronary artery has been disrupted by the laser. A dark-colored necrotic laser tract traversing the vessel from top to bottom is evident. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 1381-1385DOI: (10.1016/S0022-5223(98)70225-9) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 6 The lumen of this well-demarcated laser channel from an autopsy done 3 weeks after the operation is filled with granulation tissue, fibrosis, and multinucleated foreign-body giant cells. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 1381-1385DOI: (10.1016/S0022-5223(98)70225-9) Copyright © 1998 Mosby, Inc. Terms and Conditions