Maurício GalantierI; Geisha Barbosa MoreiraI; Rolf Francisco BubI; João GalantierI; Ênio BuffoloI; Antônio Carlos CarvalhoI; Dikran ArmaganijanII; Jozef FéherI
DOI: 10.1590/S0102-76381996000200004
RESUMO
A doença coronária aterosclerótica apresenta situações em que as técnicas cirúrgicas habituais ou as realizadas em laboratórios de hemodinâmica não são passíveis de utilização. São pacientes portadores de comprometimento grave e difuso das artérias coronárias, mas ainda com preservação da viabilidade miocárdica e que evoluem com importante sintomatologia anginosa, apesar da terapêutica clínica adequada. Técnicas de endarterectomia são preconizadas em algumas situações, porém com resultados trans e pós-operatórios muitas vezes desfavoráveis. Em outras ocasiões pode, inclusive, ser necessária a indicação de transplante cardíaco. Para este grupo de pacientes uma nova abordagem vem sendo desenvolvida a partir dos estudos do Dr. Mirhoseini, com a confecção de vários túneis transmiocárdicos com o uso de raios laser de CO2 de alta potência (850 watts). Os autores relatam sua experiência clínica inicial no Hospital Israelita Albert Einstein, em São Paulo, com a utilização da Revascularização Transmiocárdica a laser (Heart Laser) no período de abril de 1995 a fevereiro de 1996. Foram operados 11 pacientes com essa técnica (em um deles foi utilizada revascularização associada), sendo a média de idades de 68 anos. Sete deles eram casos de reoperações. Desses pacientes, 9 encontravam-se em grupo funcional IV. Houve 2 óbitos no período pós-operatório, ambos em pacientes com idade superior a 80 anos. Sete pacientes foram avaliados com 3 meses de pós-operatório, mostrando melhora clínica e maior tolerância a esforços. Em 4 pacientes foi realizado mapeamento cardíaco com isótopos e, em 1, houve melhora da perfusão. Os resultados, embora promissores, ainda requerem uma avaliação mais prolongada em um maior grupo de pacientes, para que sua utilização seja melhor estabelecida.ABSTRACT
Patients with ischemic heart disease and disabling angina, for whom CABG or PTCA is impossible, present a difficult chalenge. The Transmyocardial Laser Revascularization (TMLR) provides direct perfusion of ischemic myocardium vialaser by creating transmural channels. Since April 1995 we have treated 11 patients, 9 males, mean age 68 years, with TMLR. Preoperatively 9 were in angina class IV, despite adequate and even maximum clinical medical treatment. The patients were screened preoperatively by SESTAMIBI perfusion scan and pharmacological echocardiogram to identify the location and extention of their reversible ischemia. Operative exposure was obtained via a left anterior thoracotomy. Employing a 850W CO2 laser an average of 30 was created. Bleeding from the channels was controlled by direct finger pressure and rarely by epicardial suture. The early mortality was 2 out of 11 patients. There was no late mortality. All patients revealed improvement in their clinical status, and the mean angina class was 1,8 postoperatively; In 4 patients SESTAMIBI scan was performed at the third postoperative month, and 1 showed improvement in the myocardium perfusion. Those early results indicate that TMLR is a single operative technique that may improve myocardial perfusion and provide angina relief for patients not amenable to standard methods of revascularization. However a larger number of patients and a longer time of follow-up will be needed to have definitive conclusions.REFERÊNCIAS
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