Gassler N, Wintzer H O, Stubbe H M, Wullbrand A, Helmchen U
Department of Pathology, University Hospital Eppendorf, Hamburg, Germany.
Circulation. 1997 Jan 21;95(2):371-5. doi: 10.1161/01.cir.95.2.371.
The creation of transmyocardial channels from the epicardium to the left ventricular cavity with the use of a CO2 laser is a modern approach in the treatment of patients with chronic ischemic cardiac disease. The histological features of human myocardium at different times after transmyocardial laser therapy have not been previously described. We had the opportunity to examine hearts from patients who died without clinical evidence of a persistent therapeutic effect at 3, 16, and 150 days after transmyocardial laser revascularization (TMR) respectively.
We grossly localized the laser-created channels in unfixed and formalin-fixed tissue. Three ventricular levels were defined for cutting the hearts into four segments. Then, transmural blocks were excised and cut crosswise and lengthwise for histological investigation through the use of established staining methods. On day 3, laser-induced channels were filled with abundant granulocytes and thrombocytes, fibrinous network, and detritus and were surrounded by severe myocardial necrosis. Furthermore, the epicardial and endocardial portions were obstructed by fibrinous network and microclots. Granulocytes were mostly absent on day 16; in addition, the channels were filled with erythrocytes or fibrinous network. On day 150, we observed a string of cicatricial tissue admixed with a polymorphous blood-filled capillary network and small veins, which very rarely had a continuous wrinkled link to the left ventricular cavity.
We found different stages of wound healing in human nonresponder myocardium after TMR, resulting in scarred tissue that displayed capillary network and dilated venules without evidence of patent and endothelialized laser-created channels. Experimental studies are necessary to analyze the morphological basis for TMR-mediated effects in human responder myocardium.
使用二氧化碳激光从心外膜向左心室腔创建穿壁通道是治疗慢性缺血性心脏病患者的一种现代方法。此前尚未描述经心肌激光治疗后不同时间点人类心肌的组织学特征。我们有机会分别检查了在经心肌激光血运重建术（TMR）后3天、16天和150天死亡且无持续治疗效果临床证据的患者的心脏。
我们在未固定和福尔马林固定的组织中大体定位激光创建的通道。定义了三个心室水平将心脏切成四段。然后，切除透壁组织块，进行横向和纵向切割，通过既定的染色方法进行组织学研究。在第3天，激光诱导的通道充满了丰富的粒细胞和血小板、纤维蛋白网络及碎屑，并被严重的心肌坏死所包围。此外，心外膜和心内膜部分被纤维蛋白网络和微血栓阻塞。在第16天粒细胞大多消失；此外，通道充满了红细胞或纤维蛋白网络。在第150天，我们观察到一串瘢痕组织，混有形态多样的充血毛细血管网络和小静脉，这些小静脉很少与左心室腔有连续的皱襞连接。
我们发现TMR后人类无反应心肌存在不同阶段的伤口愈合，形成了瘢痕组织，该瘢痕组织显示有毛细血管网络和扩张的小静脉，但没有证据表明激光创建的通道通畅且有内皮化。有必要进行实验研究来分析TMR介导的人类有反应心肌效应的形态学基础。
