Experimental study of homium: YAG laser transmyocardial revascularization in acute ischemic settings with myocardial contrast echocardiography.

OBJECTIVE

To study the mechanism and effects of blood perfusion to the acute ischemic region of myocardium through Ho-YAG laser channels with myocardial contrast echocardiography.

METHODS

To produce the model of acute myocardial ischemia, we partially ligated the left anterior decending (LAD) coronary artery of canine hearts between 1st. and 2nd. diagonal branches and then performed transmyocardial revascularization in this region with Ho - YAG laser. Myocardial contrast echocardiography was made with a new generation of ultrasound contrast agent and second harmonic imaging of this region before, after ischemia and after laser revascularization. Pictures were taken with "R" wave trigger skill.

RESULTS

Acoustic density determing in the ischemia region (anterior wall) with MCE (myocardial contrast echocardiography) was obviously decreased (5.40 +/- 1.81) after the LAD was ligated,as compared with before (11.69 +/- 1.61, P < 0.01). It was increased remarkably after transmyocardial laser revascularization (TMLR) (11.2 +/- 2.01, P < 0.01) as compared with that when ischemia and approximated to that before ischemia (P > 0.05). There were no differences in acoustic density in the lateral wall (as control) among these comprehensive three periods (P > 0.05). Contrast in the laser region developed one cardiac cycle ahead of that in the non-ischemic normal region.

CONCLUSION

Acute ischemic myocardium can be perfused by oxygenated blood from the left ventricle through Ho - YAG laser channels. Evidence of blood perfusion through laser channels during systolic phase was detected, and myocardial contrast ultrasonography using intravenous perfluorocarbon-exposed sonicated dextrose albumin may be regarded as a reliable method in the study of transmyocardial revascularization.