Lasers for Ischemic Heart Disease

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.