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Use of Laser in Cardiology TRANSMYOCARDIAL LASER REVASCULARIZATION (TMR)
Presented by
Maryam Liaqat
Topics of discussion
Laser Medicine
Types of Laser
History of Transmyocardial laser revascularization
TMR
Carbon Dioxide Laser
Method of TMR
Future of TMR
Advantages of TMR
Breath new Life of Myocardium
Laser medicine
Laser is used for different purposes in medical field like
Medical diagnosis
Medical therapies
Medical surgery
Transmyocardial Laser Revascularization (TMR)
Endovascular surgery
Eye surgery
Foot and Ankle surgery
Important lasers use in medical application are
Argon laser
Carbon Dioxide
Eximer Laser
Ho:YAG Laser
Nd:YAG Laser
History of TMR
Arthur Vineberg in 1964 attempted to improve myocardial blood flow by tunneling the left internal mammary artery directly into the left ventricular myocardium
TMR is a derivative of older procedures developed before CABG surgery to augment coronary blood flow
First time it introduced in 1990’s when the Coronary Artery Bypass Surgrey (CABS) couldn’t work for patients due to some other diseases to reduce Angina pain
Pelletier MP, et al. Ann Thorac Surg. 1998;66:12–18
Transmyocardial Laser Revascularization
Angina is heart disease when lower left ventriclemuscles of heart doesn’t recieve oxygenated bloodtherefore increase the risk of heart attack andcause painful condtion
Laser drilled small holes from ventricle intomyocandium allowing blood to flow directly intothe heart muscle without the need to travelthrough blocked coronary arteries
Transmyocardial Laser Revascularization
Invasive heart surgery
Create open channels using laser (Carbon Dioxide)
Drill 10 -30 holes in about 5 minutes
Channel of 1mm diameter and 1cm apart from each other
Carbon dioxide is high power laser (800-1000W/mm2)
Energy of each laser pulse was lo-60 J
Pulse duration of lo-50 ms
Laser pulses induced during heart beats **N. Gassler and Hans-Martin in 1997 Clinical data and histological
features of transmyocardial revascularization with CO,-laser ’
Carbon Dioxide Laser
Has highest-power continuous wave laser
CO2 laser produced a beam of infrared light spot size of 9.4 and 10.6micrometer
Pulse rate is 100 microsecond
CO2 laser consists of a gas discharge with a total reflector at one end, and an output coupler at the output end
Power of CO2 laser is from milliwatts (mW) to hundreds of kilowatts (kW)
Wavelength of carbon dioxide is 1 cm−1 (30 GHz)
Gas within the discharge tube consists of around 10–20% CO2
around 10–20% Nitrogen
Few percent of Hydrogen and
Xenon or Helium
Laser Revacularization Method
https://www.youtube.com/watch?v=fXG4WystbUg
https://www.youtube.com/watch?v=4TtOLrsp5uo
Advantages of TMR
Immidiate improvment
Long term relife
Better quality of life
Totaly elimated the effect of Angina
150% improvement reported in angina patients after TMR
Only 2% patients of TMR are hospitalized after 1 year whereas
other treatmenst like CABS etc 69% patients are addmitted
Future of TMR
Angiogenesis is produced with TMR which is creation of a controlled injury to the myocardium that is natural wound-healing response.
Carbo Dioxide and mesenchymal stem cells from bone marrow injected for Angiogensis
**G.Reyes et al.,(2009) Bone Marrow LR for treating refractory angina due to diffusion coronary heart disease
Thanks for attention