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Ann Thorac Surg 1999;68:468-469
© 1999 The Society of Thoracic Surgeons

Invited Commentary

Peter Whittaker, PhD, %The Heart Institute Good Samaritan Hospital 1225 Wilshire Blvd 90017, % .

e-mail: pwhittaker@dnamail.com

Invited commentary

Clinical application of transmyocardial revascularization (TMR) has resulted in the consistent finding of significant and prolonged reductions in angina, no matter what device was used. However, this clinical success is still in search of a mechanism. The original premise, the "de-evolution" of mammalian hearts to resemble the highly trabeculated and sinusoidal cardiac structure of reptiles by the creation of multiple channels, has been discounted. A second, related hypothesis, that the channels remain open to permit blood flow directly from the left ventricular cavity through vascular connections, has not proven valid for the infrared lasers most commonly used. A third concept, that of cardiac denervation after TMR, appeared plausible and was supported by some, albeit indirect, evidence. Hirsch and colleagues appear, after a direct assessment of cardiac nerve function, to have dismissed even this idea. The authors, drawing on experience in surgery, anesthesiology and biophysics, have provided a thorough test of . . . [Full Text of this Article]


Related Article

Transmyocardial laser revascularization does not denervate the canine heart
Gregory M. Hirsch, Gregory W. Thompson, Rakesh C. Arora, Kristine J. Hirsch, John A. Sullivan, and John A. Armour
Ann. Thorac. Surg. 1999 68: 460-468. [Abstract] [Full Text] [PDF]



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