Clinically advanced therapeutic procedures are available for a group of ischemic heart disease patients who cannot be treated with standard medical management or revascularization. These procedures are called myocardial laser revascularization, transcutaneous electrical nerve stimulation, or angiogenesis by gene or cell therapy. Transmyocardial laser revascularization (TMR or TMLR) is a surgical procedure that uses a high-power carbon dioxide (CO2) laser. This laser shoots nano-pinholes or channels (strong energy pulse) through the heart muscle into the heart’s lower chambers (left ventricles). Such newly generated transmural tiny holes increase the flow of oxygen-rich blood to your heart muscle.
Moreover, it reduces angina pain (chest pain), a symptom of coronary artery disease. This carbon dioxide laser is triggered to ECG to prevent ventricular tachycardia. After this procedure, a cardiopulmonary bypass is not required.
Minimally invasive procedures
- Transmyocardial Laser Revascularization (TMLR): This procedure requires a small incision in the left side of the heart, from where the tiny channels are drilled into the heart muscle. A heart-lung bypass machine is not required during the procedure as the heart continues to beat.
- Percutaneous Transmyocardial Revascularization (PTMR): A catheter-guided laser is used to perform transmyocardial revascularization by making a tiny incision into the skin.
- Transmyocardial Revascularization and Coronary Artery Bypass Graft (CABG): Sometimes, transmyocardial revascularization is done by accompanying coronary artery bypass grafting (CABG).
Symptoms of Transmyocardial Laser Revascularization
It is a procedure to treat coronary artery blockage or narrowing when a bypass procedure is not possible. Patients of TMR may suffer from angina, and the symptoms of such condition include;
- Chest pain
- Discomfort or pressure buildup on the chest
- Pain in jaw
- Pain in neck
- Pain in the back or lower back
- Pain in arm
Some of the patients are recommended transmyocardial revascularization in the following cases;
- If you tolerate a standard therapy (angioplasty or bypass surgery).
- If you have a history of multiple bypass operations and cannot tolerate another one.
- If the heart muscles surrounding your heart are heavy and thick.
- If your angina cannot be treated with medication or medication has the worst effect on your health.
Advantages of Transmyocardial Revascularization
Transmyocardial revascularization has emerged as an effective treatment for patients suffering from chronic refractory angina. It can improve your disease symptoms, exercise capacity, and quality of life. Moreover, it can also reduce your cardiac re-hospitalization. It is the last-resort option for patients with severe angina. It is also an essential treatment in patients suffering from other disorders like diabetes and who preclude bypass surgery. A New Journal of Medicine study reveals that the patients who had transmyocardial revascularization had chest pain relief, improved daily life routine, and improved blood flow of the heart.
Complications of Transmyocardial Revascularization
The most common complications after transmyocardial revascularization are cardiac-related. After the procedure, you can suffer from myocardial infarction, ventricular arrhythmia, atrial fibrillation, heart block, and left ventricular dysfunctions. Some rare complications include cerebral microembolism, cerebral vascular accidents, pneumonia, sepsis, and death. If you are suffering from diabetes mellitus, you may face complications like angina and untreated left anterior descending (LAD) coronary artery disease.
References
- https://www.bumc.bu.edu/cardiovascular-medicine/clinical-2/transmyocardial-laser-revascularization-tmr/
- https://www.ncbi.nlm.nih.gov/books/NBK563184/#article-603.s10
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4224272/
- https://www.brighamandwomens.org/heart-and-vascular-center/procedures/transmyocardial-revascularization#:~:text=Transmyocardial%20revascularization%2C%20also%20known%20as,left%20chamber%20(left%20ventricle).
- https://emedicine.medscape.com/article/428355-technique
