Lasers for Ischemic Heart Disease: Update on Alternatives for the Treatment of Diffuse Coronary Artery Disease

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Springer Science & Business Media, 2001 - Medical - 243 pages
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With the growing age of the population, the proportion of elderly patients with diffuse coronary artery disease and severe comorbidities is increasing. The characteristics of these patients render them unsuitable for currently recognized revascularization procedures (CABG, PTCA). Therefore, there is an urgent need for new treatment modalities which could alleviate their symptoms and increase blood flow to the ischemic myocardium, while being less invasive for their fragile condition. The aim of this book is to provide an anatomical and physiological background as well as a complete review of the alternative methods of revascularization which are under development, namely transmyocardial laser revascularization, therapeutic angiogenesis and neurostimulation. TOC:Contents: Extracardiac Operations. Indirect to direct revascularization procedures. Direct coronary artery revascularization procedures. Reappraisal of indirect myocardial revascularization. Microvascular anatomy of the heart.- Direct communication with heart chambers and sinusoids. Myocardial capillaries. The Vineberg procedure: a forgotten operation?- Technical aspects of the Vineberg procedure. Vineberg and the sinusoid concept. Myocardial acupuncture: the immediate forerunner of TMLR.- Laser physics.- The Ho:YAG Cardio Genesis System. Laser interaction with tissue during TMLR. TMLR: patient selection, operative technique and perioperative care.- The pioneering era of TMLR.- Pathophysiology of TMLR.- TMLR and angiogenesis. Clinical results of TMLR.- TMLR and left ventricular function.- Adverse effects of TMLR.- Therapeutic angiogenesis: the basis.- Therapeutic angiogenesis: the results.- Combined therapy: TMLR and therapeutic angiogenesis.- Neurostimulation.
 

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Contents

Historical Background
2
The Vineberg Procedure
3
Direct Coronary Artery Revascularization Procedures
4
The Golden Age of CABG
5
The Reappraisal of Indirect Myocardial Revascularization
6
143 Neurostimulation
7
Microvascular Anatomy of the Heart
8
The Emergence of the Sinusoid Concept
10
Nontransmural Laser Channels
126
1053 Clinical Study
127
1063 Discussion
130
The Placebo Effect
132
Revascularization
133
The Texas Heart Institute Experience
134
The Initial Brigham and Womens Hospital Experience
135
The Hamburg University TMLR Trial A Long Term FollowUp
136

Myocardial Sinusoids Myth or Reality
12
Myocardial Capillaries
13
Collateral Circulation of the Heart
14
Extracardiac Anastomoses
16
Microvasculature Anatomy in Ischernic Heart Disease
18
A Forgotten Operation?
19
Distribution of Coronary Artery Disease
20
Adjuncts to the Original Procedure
22
Renewed Experimental Interest in the Original Vineberg Concept
23
Technical Aspects of the Vineberg Procedure
25
Heart Exposure
26
Arteriographic Evidence
28
Physiologic Evidence
29
Abandonment of the Procedure
30
Vineberg and the Sinusoid Concept
32
37 Conclusions
33
Myocardial Acupuncture The Immediate Forerunner of Transmyocardial Laser Revascularization
34
Other Experimental Work
36
Clinical Application
39
Laser Physics
41
522 LaserLight
42
The Physical Process of Laser Action
44
Absorption and Amplification of Light
45
Laser Devices
46
Types of Lasers
47
552 HoiYAG Laser
49
Laser Interaction with Tissue
55
Reflection Absorption and Scattering
56
General Characteristics of Laser Beams Used in Transmyocardial Laser Revascularization TMLR
57
Thermal Interaction
58
Nonthermal Interaction
61
YAG Lasers
64
623 Excimer Laser
65
Transmyocardial Laser Revascularization Patient Selection Operative Technique and Peri operative Care
68
72 Contraindications
69
Operative Technique
70
Operating Procedure
71
Channel Density
72
The Pioneering Era of Transmyocardial Laser Revascularization
74
Other Animal Models Other Results
75
Initial Clinical Applications of TMLR
76
Laser Channel Morphology
77
YAG Laser in a Pig Model
79
923 Excimer Laser
84
Comparative Studies
85
925 Conclusions
87
YAG Laser
88
933 Excimer Laser
91
Experimental Studies in Chronically Ischemic Myocardium
92
Reports Suggesting Channel Patency
93
Reports Suggesting That Channels Do Not Remain Patent
94
953 Conclusions
95
Pathophysiology of Transmyocardial Laser Revascularization
96
Is There Blood Flow Through the Channels? 1031 Experimental Studies
98
1032 Clinical Studies
102
1033 Conclusions
103
Angiogenesis and TMLR
104
1042 Chronic Studies
106
Morphometric Analysis of Neovascularization in a Pig Model
109
1044 Conclusions
124
TMLR and Nerve Destruction
125
The Lake Constance Heart Center Experience The Largest SingleInstitution Series
137
The Cambridge Study A SingleCenter Randomized Controlled Trial
138
A US Multicenter Randomized Controlled Trial
139
The European and Asian International Registry Report
140
An Indian Trial with a Younger Patient Population
141
TMLR as an Adjunct to Minimally Invasive CABG
142
YAG Laser
144
The Houston Randomized Series
145
ATLANTIC A US Multicenter Randomized Control Trial
146
A US Multicenter Randomized Controlled Trial with Refractory Class 4 Angina Patients
147
114 Excimer Laser
148
Cardiac Transplantation Allograft Vasculopathy
149
121 Introduction
151
YAG Laser
154
Clinical Studies 1231
161
131 Introduction
163
1331 Intraoperative Arrhythmias
165
Postoperative Arrhythmias
166
Left Ventricular Function
167
1362 Results
168
1363 Discussion
169
Revascularization 141 Introduction
175
Preliminary Clinical Data
176
Catheter Navigational Control A Look into the Future
177
The Thoracoscopic Approach
178
Pathophysiology 151 Introduction
179
Angiogenic Growth Factors
180
Vascular Endothelial Growth Factor
181
Scatter FactorHepatocyte Growth Factor
182
PlateletDerived Growth Factor
183
1536 Nitric Oxide
184
1538 Antiangiogenk Factors
185
Collateral Development
186
Occlusive Vascular Disease and Vascular Injury
187
1561 Atherosclerotic Plaque
188
Reendothelialization after Intimal Injury and Hyperplasia
189
The Basis
190
Potential Side Effects of Therapeutic Angiogenesis
191
Type and Method of Delivery
192
Delivery Systems for Angiogenesis by Gene Transfer
194
Gene Expression Control
195
Results
196
The Fibroblast Growth Factor FGF Family
197
Vascular Endothelial Growth Factor
200
Fibroblast and Vascular Endothelial Growth Factors Combined Administration
201
Scatter FactorHepatocyte Growth Factor
202
FGF and VEGF
203
Transmyocardial Laser Revascularization and Therapeutic Angiogenesis 181 Introduction
206
Improved Angiogenesis in TMLR Combined with Bone Protein Growth Factor Mixture
208
1832 Results
209
19 Neurostimulation
210
Neurostimulation Treatment Modalities
211
Safety Aspects
212
Effects of Neurostimulation on the Autonomic Nervous System
213
199 Conclusions
215
Conclusions
216
References
217
Abbreviations
239
Index
241
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