Detection and Assessment of Laser-Mediated Injury in Transmyocardial Revascularization

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Abstract
When channels are made through the myocardium with a laser, tissue surrounding the channels is injured. Thus, methods of examining and quantifying the histologic changes caused by laser-mediated injury are required both for comparison of different channel making protocols and also to help understand the mechanisms of transmyocardial revascularization. The two principal components of the myocardium, collagen and muscle, are both normally birefringent. This optical property can be exploited with the use of polarized light microscopy to assess tissue structure at the cellular and subcellular levels allowing several different types of injury to be detected. Increases in tissue temperature above 60 degrees C for muscle and 70 degrees C for collagen decrease their birefringence and, hence, result in decreased brightness when viewed with polarized light. Lower temperatures may cause cell membrane injury, calcium overload, and the formation of contraction bands, which appear as areas of increased birefringence. In this way, the extent of thermal injury can be assessed. The same optical properties can be used to measure cell and fiber orientation and, hence, enable assessment of mechanical disruption of the tissue after ablation. Long-term remodeling of the myocardium in the form of scar formation, increased interstitial fibrosis, and muscle disarray can also be quantified. The ability to measure the acute injury and the long-term structural consequences of that injury with the use of polarized light microscopy should prove vital in determining the optimal laser "dose" required and may also reveal information on the mechanism(s) of benefit found with transmyocardial revascularization.