Transmyocardial Laser Revascularisation: A Matter of the Right Wavelength?

Abstract

The first clinical transmyocardial revascularisation (TMR) trials were performed in the 1950s, using mechanical puncturing devices such as needles and trocars. The underlying concept, which is still being discussed by most of the groups active today, is the finding that the human heart is a long-term result of biological evolution, starting with the reptile heart, which shows very few, slightly developed, coronaries but has extensive radial flaps into the ventricle; thus, the oxygen and metabolic uptake is performed by diffusion through the surface of these intraventricular flaps. The human heart has residual so-called sinusoidal gaps which are thought to be inflated by intracardial blood through the TMR channels. So far, non of the histological findings have been able to prove this concept, although the sinusoidal gaps can be identified.