(Circulation. 2000;102:e44.)
© 2000 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Improved Regional Wall Motion 6 Months After Direct Myocardial Revascularization (DMR) With the NOGA DMR System
From the Thoraxcenter, Heart Center, Dijkzigt Hospital, Erasmus University Rotterdam, Netherlands.
A60-year-old man was
referred to our intervention laboratory for direct myocardial
revascularization (DMR). He had received maximal
medical therapy and had undergone coronary bypass surgery 10
years earlier, and his peripheral coronary
anatomy was now found to be unsuited for surgical
revascularization. In addition, the lesions on
coronary angiography proved to be unfit for
percutaneous revascularization.
Consequently, a DMR procedure was performed. We used the
NOGA nonfluoroscopic electromechanical mapping
system (Biosense-Webster) as a guidance tool to deliver laser energy at
the exact target locations. The system has been described
previously.1 2 In the
Figure
, A shows the local linear
shortening (LLS) map in the left anterior oblique view and its
corresponding bull’s-eye view (A') at baseline. The map is color-coded
(see color bar in B), ranging from red (LLS <2%) to purple (LLS
>11%), with red zones thought to delineate akinetic zones and purple
normokinetic zones.2 The bull’s-eye view shows basal
(outer circle), mid, and apical (inner circle) regions of (clockwise
from top) the anterior (small A), lateral (L), posterior (P), and
septal (S) segments. In the picture, the low LLS values in the basal
and mid portions of the posterior and lateral segments can be seen
(-1.4%, -2.5%, 2.2%, and 4.1%, respectively). Because the
unipolar voltage map suggested viability, these regions were thought to
be eligible for DMR. B and B' show the LLS map after the DMR
procedures, with the brown tags showing the precise locations of the
laser energy applications. Similar LLS values in this region support
the belief that regional wall motion improvement can be expected only
after a certain time delay and not immediately after DMR.
|
The control map taken at 6 months is shown in C and C'. The improvement of regional wall motion can easily be appreciated in C. Indeed, the posterolateral zone, formerly colored red, is now green-blue, suggesting increased LLS and thus improved wall motion. The bull’s-eye shows increases in LLS of 2.9%, 7.1%, 4.3%, and 7.2% for basal and mid portions of the posterior and lateral segments, respectively (average increase, 4.8±3.3%).
This case suggests, for the first time, a local shortening increase as a function of left ventricular wall motion improvement 6 months after a DMR procedure.
Footnotes
Reprint requests to Professor Patrick W. Serruys, Head of the Department of Interventional Cardiology, Thoraxcenter Bd 418, University Hospital Dijkzigt, Dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
References
1. Ben-Haim SA, Osadchy D, Schuster I, et al. Nonfluoroscopic, in vivo navigation and mapping technology. Nat Med. 1996;2:1393–1395.[Medline] [Order article via Infotrieve]
2.
Kornowski R, Hong MK, Gepstein L, et al. Preliminary
animal and clinical experiences using an electromechanical endocardial
mapping procedure to distinguish infarcted from healthy
myocardium. Circulation. 1998;98:1116–1124.
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||