https://cdr.lib.unc.edu/downloads/9p290c48k

ACC/AHA Guidelines for Coronary Artery Bypass Graft Surgery A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery)

ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: Summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to update the 1999 guidelines for coronary artery bypass graft surgery)

An electrosurgical probe (10) comprises a shaft (13) having an electrode array (58) at its distal end and a connector (19) at its proximal end for coupling the electrode array to a high frequency power supply (28). The shaft includes a return electrode (56) recessed from its distal end and enclosed within an insulating jacket (18). The return electrode defines an inner passage (83) electrically connected to both the return electrode and the electrode array for passage of an electrically conducting liquid (50). By applying high frequency voltage to the electrode array and the return electrode, the electrically conducting liquid generates a current flow path between the return electrode and the electrode array so that target tissue may be cut or ablated. The probe is particularly useful in dry environments, such as the mouth or abdominal cavity, because the electrically conducting liquid provides the necessary return current path between the active and return electrodes.

System and method for electrosurgical cutting and ablation

It has been recognized that there is a group of patients with severe disabling angina and coronary artery disease who are refractory to conventional forms of treatment. Although this issue has already been debated at the level of the National Societies, we felt that it was appropriate to also tackle it at the European level. This is particularly important in view of the rapid pace of growth of this problem and the lack of a standardized approach. This has encouraged the development of a variety of treatments that vary considerably in terms of cost-effectiveness and safety and require proper validation procedures. The aim of this paper is to draw attention to the problem and start a process that will lead to improvement and harmonization of the care of patients with refractory angina.

/pdf/the-problem-of-chronic-refractory-angina-report-from-the-esc-2kqviejmlo.pdf

The problem of chronic refractory angina - Report from the ESC Joint Study Group on the Treatment of Refractory Angina

Systems and methods are provided for applying a high frequency voltage in the presence of an electrically conductive fluid to create a relatively low-temperature plasma for ablation of tissue adjacent to, or in contact with, the plasma. In one embodiment, an electrosurgical probe or catheter is positioned adjacent the target site so that one or more active electrode(s) are brought into contact with, or close proximity to, a target tissue in the presence of electrically conductive fluid. High frequency voltage is then applied between the active electrode(s) and one or more return electrode(s) to non-thermally generate a plasma adjacent to the active electrode(s), and to volumetrically remove or ablate at least a portion of the target tissue. The high frequency voltage generates electric fields around the active electrode(s) with sufficient energy to ionize the conductive fluid adjacent to the active electrode(s). Within the ionized gas or plasma, free electrons are accelerated, and electronatoms collisions liberate more electrons, and the process cascades until the plasma contains sufficient energy to break apart the tissue molecules, causing molecular dissociation and ablation of the target tissue.

Systems and methods for electrosurgical tissue treatment

The possibility of revascularizing the myocardium with high-energy laser was investigated based on the finding that the laser beam could produce small channels in the tissue of the myocardium that were devoid of debris and scarring. The technique was investigated in 4 groups of 6 mongrel dogs each. In 3 of the groups, the left anterior descending (LAD) coronary artery was ligated above the first diagonal branch and the myocardium was treated with the laser energy according to the protocol of that group. In the fourth control group, the LAD artery was ligated but the myocardium was not subjected to laser treatment. In the first 3 groups, the myocardium was protected by the channels produced by the application of the laser energy. The animals were subsequently sacrificed at various intervals. In the control group, all of the animals died within 20 minutes of ligation of the artery. At autopsy, the epicardial sites of the channels created by the laser were clearly visible and a lack of charring in the channels was demonstrated. The penetration through the endocardial surface could be demonstrated. Microscopically, the channels were patent and endothelialized. It is concluded that the channels created in the myocardium effectively helped to protect the myocardium from acute coronary artery occlusion in this model in dogs.

Revascularization of the heart by laser

Methods used to revascularize ischemic myocardium have included techniques to promote collateral circulation, arterial reconstruction and coronary artery bypass grafting, and providing direct circulation from the intraventricular chamber.Methods used to revascularize ischemic myocardium have included techniques to promote collateral circulation, arterial reconstruction and coronary artery bypass grafting, and providing direct circulation from the intraventricular chamber.

Myocardial revascularization by laser

Several investigators have explored the possibility of revascularizing the ischemic myocardium from the ventricular chamber. The high energy laser was investigated as a means to accomplish this based on the finding that the laser beam could produce small channels in the myocardium devoid of debris and scarring. The technique was investigated in four groups of mongrel dogs. In three groups the left anterior descending branch of the coronary artery was ligated and the myocardium exposed to laser treatment. The fourth group was the control, the LAD was ligated but laser channels were not made. In the three groups treated by laser, the myocardium was protected by the channels. In the control group all animals died within 20 minutes of LAD ligation. Animals in the first three groups were subsequently sacrificed at various intervals. Channels were visualized grossly, microscopically they were patent and endothelialized. The results indicate channels made by laser effectively protect the myocardium from acute coronary artery occlusion.© (1982) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

M. Mirhoseini

Papers

Revascularization of the heart by laser

Myocardial revascularization by laser

Laser Revascularization Of The Heart

Iatrogenic Lutembacher's syndrome.

Laser revascularization of the ischemic myocardium