ABSTRACT
Direct observation of the intravascular atherosclerotic change provides many diagnostic information and supports successful vascular surgery. Angioscopic inspections were performed in the 23 patients who underwent laser angioplasty for the peripheral arteries and 7 patients with aorto-coronary bypass surgery in this study. Useful images could be obtained in 19 (83%) of 23 observations in the peripheral arteries, and the successful rates of angioscopic observation were influenced by the diameter and the degree of kinking of each vessel. On the other hand, intraoperative observation of coronary artery with angioscope could be performed easily in all cases. From these findings, intraoperative application of angioscopy was considered to be useful procedure for the cardiovascular surgery.
ABSTRACT
Recently, laser has been widely applied in the field of medicine and surgery. However, laser application is very rare in the cardiovascular surgery through world. Among the patients with ischemic heart disease there are some cases for whom aortocoronary bypass could not be carried out, because of small branches and diffuse stenoses of the coronary arteries. Besides, there are some problems in keeping long-term patency after vascular anastomosis especially for small-caliber vessels. For resolving these problems we have performed and continued to achieve laser works concerning, 1) myocardial revascularization by laser, 2) laser vascular anastomosis, 3) laser angioplasty. Subsequently, myocardial revascularization by high energy CO<sub>2</sub> laser could be successfully carried out experimentally. It was microscopically clarified that transventricular laser channels newly created in the ischemic myocardium were patent even 3 years after surgery. On the basis of excellent results of experimental studies laser was successfully employed in a 55 year-old male patient who had severe anginal attack and 90% stenosis of the left anterior descending coronary artery. On the other hand, vascular anastomosis by low energy CO<sub>2</sub> laser (out put 20-40mW, irradiation time 6-12s/mm) was satisfactorily utilized in 83 patients with intermittent claudication, chronic renal insufficiency and angina pectoris after a feasibility of the procedure was clearly confirmed by hemodynamic and histological examinations. Finally, laser angioplasty using Argon laser was fundamentally studied in the mongrel dogs and human cadaver. Based on the successful results of these studies, laser angioplasty was clinically applied in the 17 patients with multiple coronary stenoses or severe stenoses of the peripheral arteries. From these excellent results, laser application was inevitable for treatment in the field of cardiovascular surgery. Clinical experience of 101 patients treated by laser was reported in detail.