laser myocardial revascularization

Laser myocardial revascularization (LMR) is a new revascularization technique to overcome and compensate for the current surgical and interventional treatment of ischemic heart disease. There are two types of surgical methods: epicardial irradiation and periosteal irradiation. , began to be used in clinical practice in 1988. It is mainly used to apply a laser from the epicardium to the endocardium or from the periosteum to the epicardium to penetrate or not penetrate the ventricular wall. These channels are associated with myocardial sinusoids, Thebesian veins, and arterial-cardiovascular vessels. The anastomosis constitutes a new blood supply system, so that the oxygenated blood of the ventricle can be introduced into the ischemia from the heart chamber during the systole, that is, directly from the heart chamber, thereby improving the blood supply of the myocardium. Treating diseases: angina Indication A. After refractory angina, the refractory angina is still not satisfactory; B. proves that there is active myocardium in the ischemic myocardium; C. The patient is not suitable for interventional or surgical bypass; D. The patient's ejection fraction is 20 %the above. In general, LMR is suitable for diffuse coronary artery disease, small or multiple coronary stenosis, complete coronary occlusion, left ventricular dysfunction, previous coronary vascular occlusion but with revascularized myocardium and other Suitable for bridging patients, especially the elderly, because of their multiple organ diseases, in the late stage of heart disease, the basic heart function is poor, often not suitable for PTCA, CABG and other treatments. LMR is a newly developed revascularization technique with certain prospects. The preliminary clinical application results show that the short-term efficacy is good, but its long-term efficacy, especially the long-term existence of myocardial channel, is effective and the degree of myocardial damage is It will lead to myocardial fibrosis or severe arrhythmia and long-term mortality, which needs further observation and research. Contraindications 1. Left ventricular ejection fraction is less than 15%. 2. There is obvious congestive heart failure. Preoperative preparation Laser myocardial revascularization requires comprehensive monitoring by anesthesiologists, including electrocardiogram, esophageal ultrasound, blood pressure, peripheral oxygen saturation, balloon floating catheter (Swn-Gnz) monitoring pulmonary arterial pressure, intravenous nitroglycerin. Some people advocate intravenous lidocaine to prevent ventricular fibrillation. At the same time, prepare the intra-aortic balloon counterpulsation pump for those with severe disease. Surgical procedure At the time of surgery, the patient was 46% in the right lateral position. The fifth or sixth intercostal space was opened, and the sacral nerve was cut away from the sacral nerve. The traction line suspended the ventricle to reveal the apex, and the left side wall and the side wall. According to the laser parameters used, the laser emitting end is vertically aligned with the ischemic area, and the foot switch is controlled. One hole per 102 cm is drilled. After the laser penetrates the chamber wall, blood can be seen from the heart chamber, and the esophageal ultrasound can be simultaneously The bubbles generated by the laser vaporized blood were observed. Most of the bleeding can refer to the gauze for a moment to stop bleeding, and can be used to suspend blood in the shallow surface of the heart. If the laser does not damage the room, especially the mitral valve structure, after a few sutured pericardium or pericardial fenestration, the left chest is placed after drainage, and the chest can be smoothly closed. No reports of hemorrhage or pericardial tamponade by laser myocardial revascularization have been reported in the literature. During the operation, attention should be paid to laser safety protection to prevent ventricular fibrillation, damage to the coronary artery and mitral valve device, and to stop bleeding. complication Arteriosclerosis, cardiovascular disease, etc.