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Optica Publishing Group
  • Biomedical Optical Spectroscopy and Diagnostics / Therapeutic Laser Applications
  • OSA Trends in Optics and Photonics Series (Optica Publishing Group, 1998),
  • paper TSuD3

Endocardial Laser Revascularization with Single High Energy Laser Pulses

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Abstract

The objective of this study is to improve transmyocardial laser revascularization (TMR) with regard to minimal invasive surgery by means of a steerable heart catheter in a percutaneous approach. The holes required shall be performed from the endocardium into the ischemic myocardium by single high energy laser pulses (endocardial laser revascularization, ELR).

We developed a high energy pulsed holmium laser. Single pulse energies of up to 12 J were transmitted by multimode optical fibers. Tissue ablation was quantified on reperfused ex-vivo porcine hearts to demonstrate the capability of such approach. The ablation dynamics were investigated by use of time resolved fast flash photography. Histologic investigations using polarization light microscopy were performed to show the thermal and mechanical collateral damage ranges. For comparison, an 800 W C02 laser was also used for tissue ablation.

Cavitation bubble dynamics in water demonstrate steam bubbles with an axial length of up to 2 cm in water. Using pulse energies around 12 J, channel depths in the order of 10 mm could be achieved with both laser systems. The thermal damage range was found to be 150 µm for the CO2 and 500 µm for the holmium laser. Adjacent tissue tearing owing to the ablation dynamics were found which correspond to the direction of the myocardial muscle fibers.

The technique of single-pulse ELR demonstrates ablation craters comparable in size and thermomechanical collateral damage to those achieved with the standard CO2 laser. The results are very encouraging and demonstrate the potential of a catheter based minimal invasive procedure for laser heart reperfusion.

© 1998 Optical Society of America

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