Menno Huikeshoven

35 years of experimental research in transmyocardial revascularization: what have we learned?

In the past 35 years many experimental studies have been performed to investigate the revascularization potential of transmyocardial revascularization and the possible working mechanisms underlying the observed clinical improvement in angina pectoris after this treatment. In this review of the experimental literature, the various methods that have been used to create transmyocardial channels and the most supported hypotheses on the working mechanism (channel patency, angiogenesis and myocardial denervation) are discussed and evaluated.

Transmyocardial laser revascularisation and other treatment modalities for angina pectoris

Abstract Ischaemic heart disease is one of the leading causes of morbidity and mortality in the western world. This paper provides an overview of the different treatments for one of the most common manifestations of ischaemic heart disease: angina pectoris. Besides the currently available conventional methods, several alternative treatments are described, with a special focus on transmyocardial laser revascularisation.

The old spontaneously hypertensive rat as a model for transmyocardial laser revascularisation research

Abstract Animal models used in transmyocardial laser revascularisation (TMLR) research lack the increased fibrosis observed in patients with chronic myocardial ischaemia. This pathology has also been described in patients with chronic elevated afterload, and therefore we evaluated the spontaneously hypertensive rat (SHR) as a model for TMLR research. We compared (1) the myocardial pathology of SHR with the pathology of three TMLR patients, (2) the reaction to TMLR in SHR and human myocardium using three different lasers, and (3) myocardial hypoxia in SHR myocardium and (healthy) Wistar rat myocardium. SHR and human myocardium both showed increased fibrosis and a similar myocardial reaction to TMLR (comparable morphology of fibrotic TMLR channel scars). More hypoxic cells were observed in SHR than in Wistar control rat myocardium. The similarities between SHR and human chronic ischaemic myocardium make the SHR a suitable model for TMLR research.