Kantor B, McKenna C J, Caccitolo J A, Miyauchi K, Reeder G S, Mullany C J, Schaff H V, Holmes D R, Schwartz R S
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Rochester, MN 55905, USA.
Mayo Clin Proc. 1999 Jun;74(6):585-92. doi: 10.4065/74.6.585.
Transmyocardial revascularization (TMR) is a new treatment modality under evaluation in patients with severely symptomatic, diffuse coronary artery disease, in whom the potential for medical or interventional management has been exhausted. Preliminary clinical trials show improved ischemic symptoms within the first 3 months in about 70% of TMR-treated patients. The original proposed mechanism of surgical or catheter-based TMR (percutaneous myocardial revascularization [PMR]) was that channels mediate direct blood flow between the left ventricular cavity and ischemic myocardium. However, several alternative explanations for the clinical success of TMR have recently been suggested, including improved perfusion by angiogenesis, an anesthetic effect by nerve destruction, and a potential placebo effect. This article reviews the clinical role of TMR/PMR, its possible pathophysiologic mechanisms, and its controversies. It provides an overview of the actual scientific and clinical status of TMR and details future directions.
经心肌血运重建术（TMR）是一种正在评估中的新治疗方式，用于治疗有严重症状的弥漫性冠状动脉疾病患者，这些患者已用尽药物或介入治疗手段。初步临床试验表明，约70%接受TMR治疗的患者在最初3个月内缺血症状有所改善。最初提出的外科或基于导管的TMR（经皮心肌血运重建术[PMR]）机制是，通道介导左心室腔与缺血心肌之间的直接血流。然而，最近有人提出了几种关于TMR临床成功的其他解释，包括通过血管生成改善灌注、神经破坏产生的麻醉作用以及潜在的安慰剂效应。本文综述了TMR/PMR的临床作用、其可能的病理生理机制及其争议。它概述了TMR的实际科学和临床现状，并详述了未来方向。
