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Tuesday, October 17, 2000

By Craig T. Kojima, Star-Bulletin
Dr. Jeffrey Lee shows an X-ray to Thelma Edwards,
who endured chronic pain before the procedure.

Kailua woman
has pioneering
laser surgery

The Heart Laser System
offers an alternative to
bypass or angioplasty

By Helen Altonn

Thelma Edwards knew she had a problem when she tried to hang her wash on the line and couldn't lift her left arm without pain.

The 74-year-old retired school-teacher from Kailua was suffering from angina, or "disabling chest pain," but she wasn't considered a candidate for the usual treatments: angioplasty or bypass surgery.

Her doctor referred her to Dr. Jeffrey D. Lee, a cardiovascular and thoracic surgeon, and she became one of Hawaii's first patients to undergo a "Heart Laser System" procedure on Sept. 1 at St. Francis Medical Center.

Called TMR, or transmyocardial revascularization, it is performed on a beating heart and involves use of a high-energy, computer-synchronized carbon dioxide laser.

The laser creates channels through heart muscle deprived of oxygen and causes it to form new blood vessels.

"That's what's thought to be related to reduction of the angina (chest pain)," Lee said.

The laser is synchronized with the heartbeat and fired when the ventricle is filled with blood and the heart is relatively still.

"What it basically does is vaporize the heart muscle, shooting from outside in, so there is a clear channel in and through the left ventricle of the heart," Lee said.

The idea of creating channels for cardiac circulation came from reptiles, which do not have coronary arteries to provide blood flow to the heart, he said. Instead, internal channels supply blood from a reptile's heart chamber into the heart muscle.

The heart of a human fetus is nourished in the same way until coronary arteries develop.

Lee said the new heart-laser technology has been used in research on the mainland for about two years. Results of random trials were published only two months ago, and the procedure was approved by the Food and Drug Administration.

Lee trained in Chicago with Dr. Robert March of Rush Presbyterian Hospital. He was one of the doctors reporting on the trials in the New England Journal of Medicine two months ago.

The heart laser is intended for patients with no other options to treat severe coronary artery disease or who failed earlier bypass surgery or angioplasty attempts, Lee said.

After one year, the studies showed, more than 75 percent of the patients who underwent the heart laser had a much better quality of life than those who did not have the procedure, Lee said.

"What they also found was, patients who didn't have the procedure continued to be admitted to the hospital many times for chest pain. A very small percentage had to be admitted for chest pain who had the procedure."

Lee said many of his patients learned about the procedure on the Internet and asked him about it, but Edwards had not heard of it until he discussed it with her.

"For two years she had been living with a chronic state of chest pain whenever she exerted herself. ... It was limiting her lifestyle."

Edwards had vessels in her heart that could be bypassed, but other vessels were so small, doctors felt she would not benefit from a bypass, Lee said.

With the new technology, he said, "We were able to offer her a combination procedure with a good chance of success."

The laser procedure is less invasive than traditional bypass surgery because it generally involves a small chest incision and does not require a blood transfusion or heart-lung machine.

"I'm glad that he did it, and I hope that he perfects it a little more because he's such an excellent doctor," Edwards said.

She said her recovery "was very, very fast," and she did not have all the body aches she hears about.

"I'm doing all my work. ... I was just hanging clothes up this morning," she said.

She also hopes to resume substitute teaching. "I need to walk the treadmill Oct. 30, and I'll go back in November."

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