Improved perfusion and contractile reserve after transmyocardial laser revascularization in a model of hibernating myocardium G.Chad Hughes, MD, Alan.

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Improved perfusion and contractile reserve after transmyocardial laser revascularization in a model of hibernating myocardium G.Chad Hughes, MD, Alan P Kypson, MD, James D St. Louis, MD, Brian H Annex, MD, R.Edward Coleman, MD, Timothy R DeGrado, PhD, Carolyn L Donovan, MD, James E Lowe, MD, Kevin P Landolfo, MD The Annals of Thoracic Surgery Volume 67, Issue 6, Pages 1714-1720 (June 1999) DOI: 10.1016/S0003-4975(99)00317-3

Fig 1 Coronary angiogram showing experimental preparation. Note normal left anterior descending coronary artery (curved arrow), proximal partial occlusion of the left circumflex coronary artery (straight arrow) at the site of hydraulic occluder placement (radiolucent and not visualized), and flow probe (open arrow) located downstream from the occluder on the left circumflex artery. The Annals of Thoracic Surgery 1999 67, 1714-1720DOI: (10.1016/S0003-4975(99)00317-3)

Fig 2 Diagram of the 8 sectors used for comparing quantitative measurements of myocardial blood flow and glucose utilization in the three short-axis slices (basal, mid, and apical). Sectors 2 through 4 (lateral and posteroinferior walls of the left ventricle [LV]) were considered as representing myocardium within the left circumflex distribution. Sectors 7 and 8 served as the nonischemic control regions. The Annals of Thoracic Surgery 1999 67, 1714-1720DOI: (10.1016/S0003-4975(99)00317-3)

Fig 3 Representative baseline positron emission tomography 13N-ammonia (13NH3) perfusion scan (top left) showing a flow defect in the lateral and posteroinferior walls of the left ventricle as seen on the short axis view. Corresponding 18F-fluorodeoxyglucose (18F-FDG) uptake scan (top right) showing a relative increase in glucose utilization in the region of the flow defect consistent with preserved myocardial viability. Corresponding post transmyocardial laser revascularization (TMR) positron emission tomographic scan from the same animal. Note the increase in 13N-ammonia accumulation in the lased left circumflex distribution 6 months postoperatively (bottom left), consistent with increased blood flow. There is more homogeneous 18F-fluorodeoxyglucose uptake (bottom right) associated with this improvement in blood flow. The Annals of Thoracic Surgery 1999 67, 1714-1720DOI: (10.1016/S0003-4975(99)00317-3)

Fig 4 Normalized left circumflex artery distribution blood flow by positron emission tomography for base, mid, and apex before and 6 months after transmyocardial laser revascularization (TMR). There is a significant increase in myocardial blood flow to the lased left circumflex artery regions 6 months after transmyocardial laser revascularization. The Annals of Thoracic Surgery 1999 67, 1714-1720DOI: (10.1016/S0003-4975(99)00317-3)

Fig 5 Representative short axis echocardiographic view of the left ventricle during peak dobutamine stress before transmyocardial laser revascularization (TMR) (left) showing an inferoposterolateral ischemic wall motion abnormality. The post-transmyocardial laser revascularization image (right) shows resolution of the wall motion abnormality. Arrows denote endocardial surface. PM = location of papillary muscles in each image. The Annals of Thoracic Surgery 1999 67, 1714-1720DOI: (10.1016/S0003-4975(99)00317-3)

Fig 6 Mean regional wall motion score index (WMSI) (1 = normal; 2 = hypokinetic; 3 = akinetic; 4 = dyskinetic) at rest, low stress, and peak stress for the lateral and posteroinferior walls of the left ventricle before and 6 months after treatment with transmyocardial laser revascularization (TMR). Note the trend toward improved resting function and the significant improvement in regional wall motion score index at peak stress 6 months after transmyocardial laser revascularization. The Annals of Thoracic Surgery 1999 67, 1714-1720DOI: (10.1016/S0003-4975(99)00317-3)

Fig 7 Mean global wall motion score index (WMSI) (1 = normal; 2 = hypokinetic; 3 = akinetic; 4 = dyskinetic) at rest, low stress, and peak stress for all 16 left ventricular segments before and 6 months after transmyocardial laser revascularization (TMR). Note the significant improvement in global wall motion score index at peak stress 6 months after transmyocardial laser revascularization. The Annals of Thoracic Surgery 1999 67, 1714-1720DOI: (10.1016/S0003-4975(99)00317-3)