Study On Clinical Application And Effectiveness Of Transmyocardial Laser Revascularization

Objectives: Since l983, transmyocardial laserrevascularization (TMLR) was first used for treatment ofcoronary heart disease (CAD) by Mirhoseini, there have almostbeen more than 20 000 patients who received this treatment.This surgical approach is fit to these patients who suffercoronary heart disease, angina pectoris, but they can not becured through traditional medical methods, such as medication,percutaneous transluminar coronary angioplasty (PTCA) or6$NX#(2002Wrt&$n&Z $X.c.Mninfff$(TMLR) Mlrs$&ffi5ffnm#WRcoronary artery grafting bypass (CABG). Obviously it givesthese patients the new hope for rehabilitation. Resent years inChina, the mortality of CAD has been rising and CAD hasmade many patients disabled in China. Since l990s, China hasintroduced this method to treat CAD. From l999 to 200l, wehave given l0 patients Who suffered CAD, angina pectoristheraPy with TMLR, and got good clinical effectiveness. Toevaluate the clinical effectiveness of wi throughfollowing-up patients at preoperation and postoperation, thisstudy observing the clinical aPplication of TMLR shows that itis a safe and available method.Methods: We select 2groups patients f one group involves l0patients who suffered CAD, angina pectoris. These patientswho had accepted in hospital receive regular medication. Wecall this group as medication group. During regular medication,we can obtain the data of the myocardial enZyme, and recordthe change of CPK. CK-MB. LDH. LDH-l at 6. l2. 24.48 hours. The myocardial enzyme can prove the damage of themyocardial cells. Another group involves l0 patients who7nmX#(z0ozpertl$&&X MA,c'MAsgffi4$(TMLn) %lts$&m56aW#ff%suffered CAD, angina pectoris. These patiellts who hadaccepted in hospital receive treatment of TMLR. We call thisgrouP as TMLR grouP. We use the high power 850W CO2Heart Laser machine which was made by Beijing MeimanCompany HL- l00 type. According to the amouflt of fat locatedthe superficial heart, we can adjust the parameter of HeartLaser machine selected pulse energy 40-60, and pulse width35-55, and create the hole in the ischemic location of the leflventriculium. We can make 18M holes in each patient, anddiameter of holel.0mm, and mlltual distance of each hole isl0.0mm, and avoid to injure the coronary vessels. We mustconfirm that the hole is totally passing through the ventricularwall. When ejecting blood from the hole, the channel isconsidered successfully. We use sponges to press the hole for awhile, the blooding will stop. Otherwise, we shouId sllture theepicardium to stop blooding exactly. We recorded this groupsat preoperation and postoperation at 6. l2. 24. 48 hours aboutthe changes of CPK. CK-MB \ LDH. LDH-l. Then we can getalong comParison in them from those data. The changes of8$mX%(2002peR$$&teX $k,G'Mnin14$(TMLR) MIra$&m5fr&m#FRrtmyocardial enZymes indicate the damage of myocardial cell.Through different clinical theraPy, we can observe if TMLR doharm the myocardial cells, and fi f the damage is very serious.Therefore, we can verify if TMLR is safe. Wthin one yea p weare following-up tWo groups' patients. Through differenttreatffieflts, we can find that the treaAnellt of TMLR is moreeffective than the only treatment of medication. We followed upthe patients who get treatffieflt of TMLR. From recording thepreoperative and postoperative circumstance, we can estimatethe clinical effectiveness of TMLR. We can compare grade ofangina pectoris in l month. 6month. l2month with preoperation;duration of exercise~loaded steadmail test electrocardiogram in12 month with Preoperation, 99mTc-MIBI single-photonemission computed tomograPhy [SPECT] in l2 month withpreoperation. Therefore, we can evaluate the clinicaleffectiveness of TMLR.Results: In the medication group, the changes of myocardialenZymes at 6. l2. 24. 48 hours after occurring angina pectoris,have been recorded. In the TMLR gr...