35 years of experimental research in transmyocardial revascularization: what have we learned?

Huikeshoven, Menno; Beek, Hans van; Sloot, Jos A.P. van der; Tukkie, Raymond; Meulen, Jan van der; Gemert, Martin J. C. van

doi:10.1016/s0003-4975(01)03547-0

Cited by 15 publications

(13 citation statements)

References 92 publications

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“…23 In the present study, the decreased flow heterogeneity noted after TMLR in the surrounding area might be explained in part by alteration of the coronary anatomy due to angiogenesis and/or by changes in coronary vascular regulation due to regional myocardial denervation. 3,4,25,26 The finding of a decrease in CV with the disappearance of transmural difference is similar to the response of regional myocardial blood flow in the normal left ventricular wall to hypoxemia. 16 Thus, we speculate that TMLR might result in more uniform myocardial perfusion and more effective O2 delivery in each myocardial region in the surrounding area.…”

Section: Discussionsupporting

confidence: 70%

Digital Radiographic Quantification of Myocardial Blood Flow Around a Transmyocardial Laser Channel in Rabbit Hearts

Honjo

Ishino

Matsumoto

et al. 2005

Circ J

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Background A mechanism underlying the benefits of transmyocardial laser revascularization (TMLR) has been presumed to be improvement in perfusion. We evaluated myocardial blood flow around a laser channel using digital radiography combined with a 3 H-labeled desmethylimipramine ([ 3 H]DMI) deposition. Methods and Results A laser channel was created in the left ventricular wall using a YAG-laser in 6 nonischemic rabbit hearts. After 8 weeks, [ 3 H]DMI(1.11 MBq) was injected into the left atrium and the TMLRtreated myocardium was sectioned. Another 6 hearts were examined as controls. We measured [ 3 H]DMI density in arbitrary units with digital radiography in the channel remnant, the surrounding area and a remote area. Flow distribution was quantified by the coefficient of variation of flows (CV). The surrounding area had the highest density (p<0.001) and the lowest CV (p<0.001), and had higher density (p<0.001) and lower CV (p<0.001) than the controls. There was no transmural difference in the density in all domains. The CV increased with depth in the remote area, as well as in controls (p<0.001), but there was no transmural difference in the surrounding area. Conclusions The TMLR increases myocardial blood flow and decreases flow heterogeneity in the surrounding area. The disappearance of transmural difference in flow heterogeneity might indicate the remodeling of microcirculation to improve regional oxygen delivery. (Circ J 2005; 69: 488 -492)

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Section: Discussionsupporting

confidence: 70%

Digital Radiographic Quantification of Myocardial Blood Flow Around a Transmyocardial Laser Channel in Rabbit Hearts

Honjo

Ishino

Matsumoto

et al. 2005

Circ J

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“…Second, the Angiogenesis hypothesis claims that the clinical results of TMR may be attributed to a combination of early neovascularization promoted regionally around the small holes (increased vascular density) and increased local myocardial perfusion that develops lately after further remodeling of the angiogenic networks. Finally, the Denervation theory suggests that local myocardial denervation by the laser beam may achieve neuromodulation and/or neurodestruction of local somatosensory tissue tracts and result in alleviation of anginal pain [196]. Reports of marked clinical benefits in terms of relief of anginal symptoms have appeared from nonblinded registrytype studies, as well as nonblinded randomized clinical trials of TMR or PMR versus continued medical therapy.…”

Section: Transmyocardial Laser Revascularizationmentioning

confidence: 99%

Therapeutic angiogenesis for myocardial ischemia revisited: basic biological concepts and focus on latest clinical trials

et al. 2011

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Therapeutic angiogenesis is based on the premise that the development of new blood vessels can be augmented by exogenous administration of the appropriate growth factors. Over the last years, successful preclinical studies and promising results of early clinical trials have created great excitement about the potential of therapeutic angiogenesis for patients with advanced ischemic heart disease. The authors provide an overview of the biology of angiogenesis, the basic characteristics of angiogenic factors, and the different routes of their delivery. They discuss experimental studies in animal models of myocardial ischemia and outline available clinical studies on therapeutic angiogenesis for myocardial ischemia. Related safety issues are also addressed followed by a critical perspective about the future of proangiogenic therapies for ischemic cardiovascular disorders. Despite the established proof of concept and reasonable safety, however, results of the latest trials on therapeutic angiogenesis for myocardial ischemia have provided inconsistent results and the definite means of inducing clinically useful therapeutic angiogenesis remain elusive. More studies are required to gain further insights into the biology of angiogenesis and address pharmacological limitations of current approaches of angiogenic therapy. The authors hope and envisage that in the not-too-distant future, these investigative efforts will lead to important new strategies for treatment of myocardial ischemic syndromes. Means of non-invasive individualized pharmacological therapeutic neovascularization may be the next major advance in the treatment of ischaemic heart disease.

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“…The basis for angina prevention with TMR is unclear. The initial hypothesis was that the channels provided oxygenated blood from the LV to directly perfuse the myocardium; support for this mechanism is not compelling; more recently, it has been proposed that clinical improvement may be secondary to angiogenesis, placebo effect, or myocardial denervation (Huikeshoven et al, 2002). TMR also has been combined with administration of angiogenic growth factors and/or angiogenic gene vectors introduced via the channels to stimulate angiogenesis (see Biological Therapy, below).…”

Section: Transmyocardial Revascularizationmentioning

confidence: 99%

Therapy for Angina Pectoris Secondary to Coronary Disease

Innasimuthu¹,

Kumar²,

Gao³

et al. 2011

Angina Pectoris

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35 years of experimental research in transmyocardial revascularization: what have we learned?

Cited by 15 publications

References 92 publications

Digital Radiographic Quantification of Myocardial Blood Flow Around a Transmyocardial Laser Channel in Rabbit Hearts

Digital Radiographic Quantification of Myocardial Blood Flow Around a Transmyocardial Laser Channel in Rabbit Hearts

Therapeutic angiogenesis for myocardial ischemia revisited: basic biological concepts and focus on latest clinical trials

Therapy for Angina Pectoris Secondary to Coronary Disease

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