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J Thorac Cardiovasc Surg 2001;122:712-719
© 2001 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Cardiac nociceptive reflexes after transmyocardial laser revascularization: Implications for the neural hypothesis of angina relief

From the Departments of Internal Medicine (Cardiology)^a and Pathology,^b Medical College of Virginia, Campus of Virginia Commonwealth University, and Hunter Holmes McGuire Department of Veterans Affairs Medical Center, Richmond, Va.

Received for publication Jan 11, 2000. Revisions requested July 7, 2000; revisions received April 19, 2001. Accepted for publication April 24, 2001. Address for reprints: Anthony J. Minisi, MD, Cardiology Section (111J1), McGuire VA Medical Center, 1201 Broad Rock Blvd, Richmond, VA 23249 (E-mail: Minisi.Anthony_J.{at}Richmond.VA.Gov).

Objective: The mechanism by which transmyocardial laser revascularization relieves angina is not understood. One theory is that laser-induced thermal damage to cardiac nerves results in cardiac denervation. This study examined the acute effects of transmyocardial laser revascularization on reflex responses mediated by cardiac nociceptors, the left ventricular receptors with sympathetic afferent fibers that are thought to mediate anginal chest pain.
Methods: Experiments were performed in 13 chloralose-anesthetized dogs with sinoaortic denervation and vagotomy. Left ventricular receptors with sympathetic afferent fibers were activated by epicardial and intracoronary bradykinin before and 45 minutes after transmyocardial laser revascularization. Reflex responses elicited by bradykinin were quantitated by direct recording of efferent renal sympathetic nerve activity. Transmyocardial laser revascularization was performed in the open-chest model with a hand-held holmium:YAG laser (2.1-µm wavelength).
Results: An average of 44.5 ± 1.0 channels were created. Before transmyocardial laser revascularization, reflex increases in renal sympathetic nerve activity were elicited by both epicardial and intracoronary bradykinin. After transmyocardial laser revascularization, there was no significant attenuation in the reflex responses to either epicardial (before, 66% ± 8%; after, 100% ± 24%; P = .19) or intracoronary (before, 124% ± 37%; after, 108% ± 25%; P = .44) bradykinin.
Conclusions: Transmyocardial laser revascularization has no significant short-term effect on reflexes mediated by left ventricular receptors with sympathetic afferent fibers in anesthetized dogs. These results indicate that transmyocardial laser revascularization does not acutely interrupt the afferent nerves, which are believed to transmit the perception of anginal pain.

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