© 2003 by European Society of Cardiology
Copyright © 2003, European Society of Cardiology
Transmyocardial laser revascularization preserves regional myocardial perfusion: an MRI first pass perfusion study
aSection of Cardiovascular MRI, Department of Diagnostic Radiology, University of Minnesota Medical School, Minneapolis, MN, USA
bSection of Cardiovascular MRI, Department of Radiology, University of Minnesota, MMC 292 Radiology, 420 Delaware Street, Minneapolis, MN 55455, USA
cHeart and Lung Institute Wisconsin, N124W16862 Lover's Lane, Germantown, WI 53022, USA
dMilwaukee Heart and Vascular Clinics, 2901 W. Kinnickinnic, River Parkway 512, Milwaukee, WI 53215, USA
* Corresponding author. Present address: Medical Hospital and Clinics I, Grosshadern Hospital, University of Munich, Marchionistr. 15, 81377 Munich, Germany. Tel.: +49-89-7095-2229; fax: +49-89-7095-2227. omuehlin{at}med1.med.uni-muenchen.de
Objective: It is controversial whether transmyocardial laser revascularization (TMLR) improves myocardial perfusion. Therefore, we assessed myocardial perfusion before and after TMLR with quantitative magnetic resonance perfusion imaging (MRPI) in an animal study. Methods: One week after partial occlusion of the left circumflex artery (LCx) in 12 pigs, resting perfusion (ml/g/min), perfusion reserve (PR) with adenosine, regional wall thickening (RWT), cardiac output (CO) were quantified with MRI in the LCx (lateral) and LAD (septal) dependent myocardium. Subsequently, six animals were treated with TMLR of the lateral left ventricle (LV). Six animals were left untreated. A final MR was performed 8 weeks later. MRPI data were compared to microsphere-derived blood flow and % LV necrosis (TTC). ‘Normal’ myocardial perfusion was assessed with MRPI in 12 non-instrumented animals. Results: Resting perfusion prior to TMLR (0.7–0.9±0.3) in the LV-lateral myocardium was preserved after TMLR (1.0±0.3) and decreased without TMLR (0.3±0.1, P<0.05). There was a significant difference (P<0.01) between the TMLR treated and untreated group. Compared to ‘normals’ (1.2±0.2) perfusion of the LV-lateral wall was not different after TMLR but reduced (P<0.02) without TMLR. PR was not different between TMLR-treated (1.4±0.9) and untreated (1.9±0.6) group but was reduced (P<0.04) compared to PR of ‘normals’ (2.7±0.8). MRPI data and microsphere-derived perfusion were significantly correlated (P<0.01). RWT in the LCx-dependent myocardium improved (P<0.02) after TMLR. CO decreased (P<0.02) and TTC-staining indicated more LV-necrosis without TMLR (6.6±1.6 vs. 3.7±1.5, P<0.01). Conclusion: TMLR preserves regional myocardial perfusion and improves function as shown with MRPI.
KEYWORDS Cardiovascular surgery; Coronary circulation; Infarction; Microcirculation; NMR; Regional blood flow; Stunning
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