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J Thorac Cardiovasc Surg 2001;122:647-648
© 2001 The American Association for Thoracic Surgery

Editorials

Shedding light on denervation and transmyocardial laser revascularization

Keith A. Horvath, MD

From the Department of Cardiac and Thoracic Surgery, Northwestern Medical Faculty Foundation, Chicago, Ill.

Received for publication June 5, 2001. Accepted for publication June 8, 2001. Address for reprints: Keith A. Horvath, MD, Department of Cardiac and Thoracic Surgery, Northwestern Medical Faculty Foundation, 201 E Huron Ave, 10-125, Chicago, IL 60611-3008.

See related article on page 712.

With more than 6000 patients treated and with 70% to 75% of these patients having a significant improvement in their angina symptoms, one would think that the mechanism whereby transmyocardial laser revascularization (TMLR) achieves its effect would be well understood. Of the many possible mechanisms, including angiogenesis, channel patency, alterations of ventricular compliance, placebo effect, and denervation, it is the latter that is the most difficult to prove or disprove. Clinical studies have indirectly demonstrated that denervation does not play the primary role, a virtue of improvement in perfusion, as demonstrated by nuclear spec scans and positron emission tomograpic scans.Go Go 1-5 Additionally, functional improvement with dobutamine stress echocardiographyGo 6 and cine magnetic resonance imagingGo 7 . . . [Full Text of this Article]


Related Article

Cardiac nociceptive reflexes after transmyocardial laser revascularization: Implications for the neural hypothesis of angina relief
Anthony J. Minisi, On Topaz, M. Susan Quinn, and Laxmi B. Mohanty
J. Thorac. Cardiovasc. Surg. 2001 122: 712-719. [Abstract] [Full Text] [PDF]





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