Intraoperative arrhythmias and tissue damage during transmyocardial laser revascularization Kâmuran A. Kadipaşaoǧlu, PhD, Michele Sartori, MD, Takafumi.

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Presentation transcript:

Intraoperative arrhythmias and tissue damage during transmyocardial laser revascularization Kâmuran A. Kadipaşaoǧlu, PhD, Michele Sartori, MD, Takafumi Masai, MD, Hasan B. Cihan, MD, Fred J. Clubb, DVM, PhD, Jeff L. Conger, BS, O.H. Frazier, MD The Annals of Thoracic Surgery Volume 67, Issue 2, Pages 423-431 (February 1999) DOI: 10.1016/S0003-4975(98)01135-7

Fig 1 Representative electrocardiographic and aortic pressure tracings obtained during transmyocardial laser revascularization. (A) Ho:YAG laser fiber firing toward, and away from, the ventricular cavity. Runs of three or more premature ventricular contractions in a row are interrupted when the fiber is not in direct contact with the myocardium. (B) Ho:YAG fiber penetrating the myocardium while not firing and while firing. The arrhythmias are more severe when the muscle is irradiated. (C) Xe:Cl laser irradiation of the heart. (D) CO2 laser irradiation of the heart. Brief elevation of the R-wave amplitude coincides with laser activation. (E) CO2 laser irradiation of the heart without electrical disturbance of the myocardium. The Annals of Thoracic Surgery 1999 67, 423-431DOI: (10.1016/S0003-4975(98)01135-7)

Fig 1 Representative electrocardiographic and aortic pressure tracings obtained during transmyocardial laser revascularization. (A) Ho:YAG laser fiber firing toward, and away from, the ventricular cavity. Runs of three or more premature ventricular contractions in a row are interrupted when the fiber is not in direct contact with the myocardium. (B) Ho:YAG fiber penetrating the myocardium while not firing and while firing. The arrhythmias are more severe when the muscle is irradiated. (C) Xe:Cl laser irradiation of the heart. (D) CO2 laser irradiation of the heart. Brief elevation of the R-wave amplitude coincides with laser activation. (E) CO2 laser irradiation of the heart without electrical disturbance of the myocardium. The Annals of Thoracic Surgery 1999 67, 423-431DOI: (10.1016/S0003-4975(98)01135-7)

Fig 2 Incidence of arrhythmias during transmyocardial laser revascularization with three laser modalities. (A) Number of arrhythmic events per channel. (B) Percentage of channels with an arrhythmic event. (CO2-R = CO2 laser synchronized to fire on the R wave; CO2-T = CO2 laser synchronized to fire on the T wave; Ho:YAG = holmium:yttrium aluminum garnet laser; PVC = premature ventricular contraction; VTach = ventricular tachycardia; Xe:Cl = xenon-chloride laser.) The Annals of Thoracic Surgery 1999 67, 423-431DOI: (10.1016/S0003-4975(98)01135-7)

Fig 3 Gross and histologic appearance of myocardial tissue after treatment with a Ho:YAG laser operated at a pulse energy of 2 J, pulse duration of 250 × 10−3 s, and pulse frequency of 10 s−1. (A) Transmural appearance of the track in a longitudinal section, showing the zigzag nature of the track. (B) Photomicrograph of a midmural section. Open arrows show laser channels, closed arrows show the borders of the zone of irreversible coagulation damage, and arrowheads show the zone of reversible damage, with an admixture of changes (see Results for details; hematoxylin and eosin stain; original magnification, ×40.) The Annals of Thoracic Surgery 1999 67, 423-431DOI: (10.1016/S0003-4975(98)01135-7)

Fig 4 Gross and histologic appearance of myocardial tissue after treatment with an Xe:Cl laser operated at a pulse energy of 0.035 J, pulse duration of 20 × 10−9 s, and pulse frequency of 30 s−1. (A) Transmural cross-section of an irregular channel. (B) Photomicrograph of a subepicardial section. Open arrows show laser channels, closed arrows show the borders of the zone of irreversible coagulation damage, and arrowheads show the zone of reversible damage with an admixture of changes (see Results for details; hematoxylin and eosin stain; original magnification, ×40.) The Annals of Thoracic Surgery 1999 67, 423-431DOI: (10.1016/S0003-4975(98)01135-7)

Fig 5 Gross and histologic appearance of myocardial tissue after treatment with a CO2 laser operated at a pulse energy of 20 J and pulse duration of 19 × 10−3 s. (A) Transmural cross-section. (B) Photomicrograph of a midmural section. Open arrows show laser channels, closed arrows show the borders of the zone of coagulation damage, and arrowheads show the zone of reversible damage with an admixture of changes (see Results for details; hematoxylin and eosin stain; original magnification, ×40.) The Annals of Thoracic Surgery 1999 67, 423-431DOI: (10.1016/S0003-4975(98)01135-7)