Myocardial revascularization by laser: a clinical report.

Methods used to revascularize ischemic myocardium have included arterial reconstruction, coronary artery bypass grafting, providing direct circulation from the intraventricular chamber, and techniques to promote collateral circulation. Ventricular channels from the epicardial surface through the endocardium are readily made with the CO2 laser. Animal experiments suggest that these channels protect the ischemic myocardium and provide circulation to the muscle from the ventricular chamber. Clinical use of the CO2 laser in conjunction with aortocoronary bypass grafting is reported in a patient with three-vessel coronary artery disease and total occlusion of the left anterior descending coronary artery (LAD), and hypokinesis of the anterior wall and apex. Following bypass a series of laser channels were made in the hypokinetic area of the left ventricle. Postoperative myocardial Tc PYP scans were within normal limits, including the previously dyskinetic anterior apical area. Serial EKGs remained unchanged from the preoperative status. Creatinine phosphokinase-myocardial band (CPK-MB) was elevated to 6 on the first and second postop day and was 0 from the third day. The patient was not recatheterized. The technique of myocardial revascularization by laser may be a viable addition to present treatment modalities. Further investigation and long-term follow-up are needed.