冠動脈バイパス不能例に対するレーザーの応用

Abstract

Recently, the number of surgery for ischemic heart disease has been widely increased and good results have been obtained.However, there were a few patients for whom A-C bypass could not be carried out, because of diffuse multiple stenoses or small caliber coronary arteries.For the purpose to rescue those severely ill patients high energy CO2 laser was employed experimentally. Subsequently, it was finally clarified that laser output more than 80W and irradiation time of approximately 0.2 sec were necessary to make a laser puncture in the ischemic myocardium.In the long-term observation of microscopic findings of the newly created laser channels it was surely recognized that laser channels surrounded by the endothelial cells were patent even 3 years after creation.On the basis of our excellent experimental results laser method was successfully carried out for a 55 year-old male patient with severe chest pain and constrictive pericarditis. Coronary angiogram showed 90% of stenosis of the left anterior descending artery (LAD). But in this case A-C bypass could not be done, because of severe adhesion of the epicardium. Therefore, six laser punctures were created in the anterior wall of the left ventricle on 12th November 1985.Postoperative course was uneventful without any complications.