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Ann Thorac Surg 1999;68:130
© 1999 The Society of Thoracic Surgeons

Invited Commentaries

Kamuran A. Kadipasaoglu, PhD, O.H. Frazier, MDa

a Cullen Cardiovascular Research Laboratories, Department of Cardiovascular Surgery, Texas Heart Institute, MC1-268, Box 20345, Houston, TX 77225-0345, USA

e-mail: kkadison@biost.1.thi.tmc.edu.

Invited commentary

Mueller and colleagues propose that angiogenesis is the sole mechanism responsible for the success of transmyocardial laser revascularization (TMLR). They believe that the channels created by the laser are replaced by scar tissue that acts as a substrate for angiogenesis. The authors suggest that this substrate is more efficient than that produced by infarcted myocardium. In principle, their hypothesis leaves two important questions unanswered. First, if additional blood is indeed reaching the myocardium, as nuclear scans of randomized clinical trials in the United States have indicated, what is the source of that blood if not patent endocardial connections? And second, if angiogenesis (which needs at least 6 weeks to reach . . . [Full Text of this Article]


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