Akay Mehmet H, Cheong Benjamin Y, Frazier O H
Department of Diagnostic Radiology, Texas Heart Institute, Houston, TX 77225-0345, USA.
Heart Surg Forum. 2009 Aug;12(4):E199-201. doi: 10.1532/HSF98.20081090.
Transmyocardial laser revascularization (TMLR) is an alternative treatment modality for patients with refractory angina who are not candidates for conventional surgical or percutaneous revascularization. Clinical studies of TMLR have not shown one-to-one correlation between increased myocardial perfusion and improved clinical status.
Three patients (51, 53, and 70 years old) with severe, diffuse coronary artery disease not amenable to conventional surgical revascularization and with angina (Canadian Cardiovascular Society [CCS] class 3-4) refractory to maximal medical therapy underwent TMLR with a CO2 laser. Preoperative and postoperative cardiac magnetic resonance imaging (MRI) were performed to assess left ventricular perfusion and wall-motion changes in the laser-treated areas. Postoperative MRIs were performed within 6 months of TMLR and at 12 months. Angina status was assessed with the Seattle Angina Questionnaire.
Postoperative adenosine stress myocardial perfusion imaging with MRI revealed improved overall perfusion and a reduction in subendocardial hypoperfused areas when compared to preoperative images. In all patients, an improvement in CCS class was consistent with an improvement in perfusion.
Cardiac MRI can be used to assess improved subendocardial perfusion after TMLR treatment. In our study, we found that endocardial perfusion was maintained over a 12-month period.
经皮心肌激光血运重建术（TMLR）是一种为难治性心绞痛患者提供的替代治疗方式，这些患者不适合传统的外科手术或经皮血运重建术。TMLR的临床研究并未显示心肌灌注增加与临床状况改善之间存在一一对应的关系。
3例患者（年龄分别为51、53和70岁）患有严重弥漫性冠状动脉疾病，不适合传统外科血运重建术，且对最大药物治疗无效的心绞痛（加拿大心血管学会[CCS]3-4级），接受了二氧化碳激光TMLR治疗。术前和术后进行心脏磁共振成像（MRI），以评估激光治疗区域的左心室灌注和壁运动变化。术后MRI在TMLR后6个月内及12个月时进行。使用西雅图心绞痛问卷评估心绞痛状况。
与术前图像相比，术后腺苷负荷心肌灌注MRI显示总体灌注改善，心内膜下灌注不足区域减少。在所有患者中，CCS分级的改善与灌注改善一致。
心脏MRI可用于评估TMLR治疗后心内膜下灌注的改善情况。在我们的研究中，我们发现心内膜灌注在12个月期间得以维持。
