Transmyocardial laser revascularization

transmyocardial laser revascularization procedure in Iran

During transmyocardial laser revascularization procedure

During Percutaneous Myocardial Revascularization (PMR)

After transmyocardial laser revascularization (TMLR) process
What can you expect after TMR?
What is the meaning of revascularization?

 

What is a TMR procedure?

 TMR, or transmyocardial laser revascularization, is a new treatment aimed at improving blood flow to areas of the heart that were not treated by angioplasty or surgery. A special carbon dioxide (CO2) laser is used to create small channels in the heart muscle, improving blood flow to the heart muscle.

What is the meaning of revascularization?

In medical and surgical therapy, revascularization is the restoration of perfusion to a body part or organ that has suffered ischemia. It is typically accomplished by surgical means. Vascular bypass and angioplasty are the two primary means of revascularization.

Read more about: Types Of Heart Surgery

Read more about: Heart arrhythmia causes

Good candidates for TMR

You may be a candidate for the TMR procedure if:

  • You have angina due to advanced cardiovascular disease
  • Your physician believes that you are not a candidate for standard therapy (such as balloon angioplasty or bypass surgery)
  • The heart muscle around these affected blood vessels is healthy
  • We cannot manage your angina with medications or the medications are causing serious side effects

TMR may not be appropriate if you:

  • Are unable to undergo general anesthesia
  • Have had a heart attack (myocardial infarction) within three weeks
  • Have uncontrollable or severe heart rhythm problems. Learn more about arrhythmias. 
  • Have debilitating chronic lung disease, such as chronic obstructive pulmonary disease, which significantly impairs your ability to breathe
  • Have heart failure, also known as congestive heart failure

Read more about: Heart attack

Read more about: Heart transplantation

During transmyocardial laser revascularization procedure

You will be asleep during surgery. First, an anesthesiologist inserts a breathing tube into your trachea (the airway from your mouth to your lungs). This tube will help you breathe during surgery.

Next, the surgeon makes an incision in your chest.

If you are undergoing TMR only, the surgeon usually makes an incision in the left side of the chest.

If you are undergoing TMLR plus bypass surgery, the surgeon may make the incision in the front of the chest and split the breastbone.

If you are undergoing coronary artery bypass surgery at the same time as TMLR, the surgeon will also redirect blood from the heart to bypass machine. The bypass machine does the job of the heart and lungs during the operation. The bypass machine is usually not needed if you are undergoing TMLR by itself.

Once the heart is exposed, the surgeon places a laser handpiece on the area of the left ventricle to be treated .

The surgeon then uses a computerized laser to create 20 to 40 small channels, each approximately 1 millimeter in diameter, in the heart muscle

The laser is controlled by a computer, which synchronizes it with your heartbeat. The channels are made when the heart is in systole, which means that the ventricle is filled with blood and the heart wall is the thickest. This helps prevent electrical disturbances, abnormal heart rhythms and damage to the heart muscle.

The channels may bleed for a moment or two, but the tops of the channels quickly clot and seal.

After the channels have sealed, the surgeon then closes the incision (and the breastbone, if it was opened). The surgeon then applies bandages to the incision site.

During Percutaneous Myocardial Revascularization (PMR)

The surgeon injects local anesthetic into an area on the groin and then makes a tiny incision to place a catheter (thin tube) in the femoral artery. A fiber-optic catheter is then placed inside the first catheter and guided through the blood vessels to the heart.

A high-energy laser beam is then emitted from the catheter through the endocardium of the left ventricle to the myocardium. In other words, the laser creates a hole through two layers of heart muscle from inside out. Once PMR is completed, the catheters are removed and the incision closed.

Read more about: What is the success rate of heart valve replacement surgery?

Read more about: Closed heart surgery indications

After transmyocardial laser revascularization (TMLR) process

Transmyocardial laser revascularization Recovery

After transmyocardial laser revascularization (TMLR) surgery at UW Health in Iran you will be moved to the intensive care unit (ICU). You will remain in the ICU for at least one day while we monitor your heart function, blood pressure, and other vital signs. In most cases, we are able to remove the breathing tube within six to eight hours of surgery.

You will then be moved to a regular hospital room. During your stay, we will give you medication to prevent blood clots and manage any other diseases, such as high blood pressure, high cholesterol or diabetes.

If you underwent TMR only, you should be able to go home three to five days after surgery. If you underwent TMR plus bypass, you should be able to go home 4-10 days after surgery.

Once you are home, we advise you to:

  • Eat a heart-healthy diet
  • Get regular exercise
  • Maintain a healthy weight
  • Quit smoking

If you have had bypass surgery with TMLR, you also should not lift more than 10 pounds for the first month after surgery. This allows your breastbone to heal.

You should be able to return to work within 2-3 months after surgery.

Read more about: Heart bypass surgery procedure

Read more about: Heart bypass surgery recovery

What can you expect after TMR?

After TMR, some patients feel immediate relief from angina symptoms, while others feel improvement over time. Some patients do not have improved symptoms after TMR, but may have improved activity tolerance. After TMR, you may still be required to take medications to help your heart and improve blood flow to the heart. You will need to meet with a cardiologist for frequent follow-up visits so your progress after TMR can be evaluated.

Read more about: Closed heart surgery definition

Read more about: Heart arrhythmia cure

 

10 common questions about transmyocardial laser revascularization procedure in Iran

1What is a TMR procedure?
TMR, or transmyocardial laser revascularization, is a new treatment aimed at improving blood flow to areas of the heart that were not treated by angioplasty or surgery. A special carbon dioxide (CO2) laser is used to create small channels in the heart muscle, improving blood flow to the heart muscle
2What does revascularization mean?
In medical and surgical therapy, revascularization is the restoration of perfusion to a body part or organ that has suffered ischemia. It is typically accomplished by surgical means. Vascular bypass and angioplasty are the two primary means of revascularization.
3What is revascularization of the heart?
Myocardial revascularization is an alternative procedure for patients with ischemic heart disease who aren't candidates for other interventions such as heart bypass surgery due to procedure failure, widespread coronary artery disease, small coronary arteries, or cardiac stenosis (thickening or stiffening of the heart
4What is the difference between a stent and angioplasty?
Angioplasty involves temporarily inserting and inflating a tiny balloon where your artery is clogged to help widen the artery. Angioplasty is often combined with the permanent placement of a small wire mesh tube called a stent to help prop the artery open and decrease its chance of narrowing again
5What is TMR mean?
TMR means "Tomorrow" So now you know - TMR means "Tomorrow" - don't thank us. YW! What does TMR mean? TMR is an acronym, abbreviation or slang word that is explained above where the TMR definition is given.
6What does TRMS mean?
The Rachel Maddow Show TRMS stands for The Rachel Maddow Show (radio program) Suggest new definition. This definition appears frequently and is found in the following Acronym Finder categories: Slang/chat, popular culture.
7How do they remove plaque from arteries?
The surgeon removes the plaque inside the artery. After the plaque is removed, the artery is closed with stitches. Blood now flows through the artery to your brain. Your heart activity will be monitored closely during surgery.
8Is stent considered revascularization?
Percutaneous coronary intervention (PCI), which involves placement of intracoronary stents in most patients, is a less invasive procedure than coronary artery bypass graft (CABG) surgery. ... It is in this patient population where the debate over revascularization with stents versus surgery continues
9Can a stent collapse?
A CT scan showed that the stent had collapsed but blood was passing through arteries around the stent. ... A more common problem is blockage of the stent caused by the body's healing response. The blockage can be partial or total. Once a stent is placed in a coronary artery, it can't be taken out.
10What is lower extremity revascularization?
Lower Extremity Revascularization. Indication: Claudication (pain in the legs from walking), ischemic rest pain, or non-healing wounds. Preoperative Evaluation: ... This more precisely quantifies the amount of circulation to the legs

3 Comments

  1. Avatar Justin says:

    Long time supporter, and thought I’d drop a comment.

    Your wordpress site is very sleek – hope you don’t mind me asking
    what theme you’re using? (and don’t mind if I steal it?
    :P)

    I just launched my site –also built in wordpress like yours– but the theme slows (!) the site down quite a bit.

    In case you have a minute, you can find it by searching
    for “royal cbd” on Google (would appreciate
    any feedback) – it’s still in the works.

    Keep up the good work– and hope you all take care of yourself during the coronavirus scare!

    • Iranian Surgery Adviser Iranian Surgery Adviser says:

      hello dear Justin, thank you so much that’s very kind of you. We’ll review your website for sure and keep you posted.

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