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Protecting Your Heart
Helping the Heart Grow New Blood VesselsAllentown man is proof of the value of 'TMR' procedure.Bob Wiley of Allentown was only 50 back in 1998, but all his former energy had disappeared. “As soon as I got home from work, I went to bed,” he says. Since he worked as a cardiac technician at Lehigh Valley Hospital and Health Network, Wiley knew this symptom might mean a cardiac problem, even though he wasn’t having chest pains. Sure enough, a thallium stress test showed total blockage in one artery and near-total blockage in others.The timing was perfect for a brand-new procedure called TMR (transmyocardial laser revascularization). “The procedure involves using a laser to make a series of small holes in the heart,” says Raymond Singer, M.D., thoracic surgeon at Lehigh Valley Hospital and Health Network. Scientists are not sure of the exact mechanism, he says, but the theory is that the inflammation caused by the laser prompts tiny blood vessels to grow within the heart muscle. The process is called angiogenesis. The concept behind TMR has been around since the 1950s, Singer says. Researchers observed that reptiles have direct channels in their heart muscles through which blood passes. They reasoned that making similar channels in human heart tissue might benefit patients with coronary problems, but they lacked effective technology. In the 1990s, when heart lasers were developed, surgeons started to re-explore the old idea. Singer and his colleagues began performing TMR in 1998, and dozens of patients have benefited from it since then. This summer, the hospital acquired the next generation of laser equipment. The new laser is more efficient and safer than previous devices, and early results are excellent. The actual technique is simple and can be done in 20 minutes once the heart is exposed. The surgeon uses a hand-held laser wand, which he places on the heart and applies a burst of energy. Typically, the surgeon makes 10 tiny holes (less than a millimeter each) in the affected area. In severe cases, as many as 30 to 40 holes may be needed. Remarkably, the holes seal themselves on the surface of the heart, leaving the channels and angiogenesis process intact underneath. “TMR can be used in combination with either angioplasty or bypass surgery,” Singer says. “For example, a patient may have two blood vessels that lend themselves to bypass or stenting, but a third area too diseased for either. If the patient has a lot of pain from this region, TMR can be helpful.” The surgeon also may use TMR alone if the patient has chronic angina (severe chest pain) and is too frail for bypass surgery and/or angioplasty. “The long-term results of TMR for patients are excellent,” Singer says. Wiley would say “amen” to that. After eight weeks of re-covery, he went back to work and has been healthy ever since. “There is no doubt in my mind that this surgery saved my life,” he says. “I eat a healthy, low-fat diet, and my job at the hospital involves a lot of walking,” he says. “But now, when I come home I still have enough energy to take my dogs for a walk.” This page last updated 2/12/08 04:08 PM
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