Heart of the matter

When 68-year-old David McCullough, a retired high school teacher from Black River Falls, Wis., needed heart surgery in September 2009, he was apprehensive. That’s because his heart surgeon explained that, in addition to bypass surgery to open blocked coronary arteries, he wanted to “drill” holes in David’s heart muscle.

Transmyocardial laser revascularization
The procedure proposed to David was transmyocardial laser revascularization or TMR. According to Gundersen cardiothoracic surgeon Venki Paramesh, MD, who performed David’s heart surgery, “The theory behind TMR is that it promotes the growth of new blood vessels as part of the body’s natural healing process. This helps minimize symptoms related to the compromised blood flow.”

Because TMR promotes improved blood flow, it helps reduce or eliminate chronic angina. Angina is chest pain or discomfort that occurs when heart muscle doesn't get enough oxygen-rich blood, usually due to blockages in the arteries that supply blood to the heart. Angina can feel like pressure or squeezing in the chest. For some, it may feel like indigestion, as was the case with David.

“For three days I had what I thought was heartburn. I finally called my primary care doctor, Jeff Polizin, MD, who told me to have my wife drive me to the clinic immediately,” David recalls.

At the Krohn Clinic in Black River Falls, blood tests confirmed what David’s doctor suspected—it was not heartburn but a heart attack. David was quickly transported to Gundersen in La Crosse. Once stabilized, cardiothoracic surgeons at Gundersen explained to David that he needed surgery, including the TMR procedure.

A medical blueprint
As a high school teacher David McCullough taught classes such as woodworking, drafting, auto mechanics, construction, and small engine repair. David likes to know how things are designed, how they work and how to fix them. So when it came to his heart, he naturally wanted to know what the doctors had in mind.

“When the doctors first told me about their treatment plans, I wasn’t sure I wanted to go through with the TMR,” says David. “They then created a ‘blueprint’ of what they were going to do so I could get my head around it. Pictures—or blueprints in this case—are worth a 1,000 words.”

“My son also helped convince me saying, ‘When you work on your car, unhooking and hooking up plug wires and hoses, well that’s a no brainer for you. To the doctor doing the TMR is just like that. They do things like this all the time and I have some more things I want to do with you,’” remembers David.

That was all the convincing David needed to have the TMR procedure.

How TMR works
“We use a special laser to precisely create 10 to 40 very narrow channels in the muscle of the left ventricle—the heart chamber responsible for pumping blood throughout the body. This promotes the growth of new blood vessels to supply blood to the heart muscle,” Dr. Paramesh explains.

TMR can be performed as sole therapy when bypass surgery or angioplasty and stenting are not possible. TMR can also be done as adjunctive therapy in combination with bypass surgery as in David’s case. TMR is performed as adjunctive therapy when one or more of the hearts vessels are not of adequate quality for bypass or angioplasty and stenting alone to be successful.

“Research shows about 75 percent of patients have a significant improvement one year after the procedure,” Dr. Paramesh adds. “At five years, 68 percent of the patients still report lasting relief.”

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