Device for influencing the myocardium using laser radiation
(57) Abstract:The invention relates to medical equipment. The device can be used for heart surgery in the treatment of ischemic heart disease, myocardial infarction. The device contains a laser multi-channel setup and a focusing device, which consists of two consecutive parts. One part is the multi-segment lens or mirror system, and the other focuses the entire system bundles in General. The technical result is to reduce the time of surgery. 4 Il. Device for laser effects on the myocardium relates to the field of laser medical equipment and can be used in the treatment of coronary heart disease, namely, when the operation transmyocardial revascularization.The known device - installation for transmyocardial revascularization  includes a powerful CO2the laser, which is synchronized with the beating of the patient's heart using ECG. The pulse generated by the laser immediately after reaching the R-wave and before the tooth T. the Beam of CO2laser, which is supplied to the heart through the long swivel arm, ending lines of deadening fabric. Thus, in the volume of infarction consistently breaks 30-40 holes (channels). Inlet channel, lying on epicardial surface of the myocardium during surgery is in contact with air and sealed coagulating blood. The remainder of the hole under pressure is filled with blood from the ventricles of the heart. This provides a partial supply of blood and nutrients to muscles of the myocardium.This device required for the operation transmyocardial revascularization [1, 2,], most closely on the implementation of the present invention and accepted by us for the prototype.The disadvantages of this device include a relatively large duration of the performed operations. This is due to the fact that the holes punched in the myocardium sequentially, one after the other. For punching the channel in the myocardium takes time to supply long hinge mechanism to the place of punching, binding the synchronization of the laser pulse with the passage R and T teeth ECG patient monitoring ultrasound punched each channel. In addition, after each laser pulse, you must wait the time required for monitoring the response of the myocardium n is the volume of the hole.The problems to be solved by the invention is the enhancement of the operational capabilities of the device for operation effects on the myocardium by means of laser radiation, reducing the time of surgery on the heart and reducing the risk of the operation.The above problems are solved (Fig. 1) that the effect of laser radiation on the heart are powerful multiband laser, at one point of convergence of the beams 4 with the further divergence of the beams 5 in the thickness of the myocardium 6, the energy of the radiation pulse and its duration depend on the required length of the channel in the myocardium. The length of the channels are different due to the fact that the beams of laser radiation falling on the heart from different angles. The greater the angle of incidence of the beam on the epicardial surface, i.e., the longer the channel, the more energy must be contained in a beam through a perforation of the myocardium.The use of multi-channel impact of laser radiation on muscle infarction will dramatically reduce the time required to carry out the above operations, which can significantly affect the risk reduction operations.The convergence of the rays on epicardial surface of the myocardium with almostly blood (the number of holes decreases sharply compared with the prototype and, therefore, reduced blood loss during surgery).The convergence of the rays on endocardial surface of the myocardium (Fig. 3) gives a significant advantage in cases when, on the contrary, the patient increased coagulability of blood and there is a risk of blood clots (thrombus) in a moment of complete punching attack and release radiation into the heart, in this case, the number of holes on endocardial (inner) surface of the myocardium decreases sharply compared to the prototype.During normal blood clotting combination of the points of convergence of the rays on epicardial surface and endocardial surface muscles of the myocardium allows greater fill volume of the myocardium with blood and thereby to ensure the maximum possible effect from the operation (Fig. 3).Alternatively, when breaks through only one channel of larger diameter and there are many more subtle channels formed in one pulse with a vanishing point inside the myocardium, and is located on the axis of the channel of large diameter. As a network of subtle channels of the blind, while the Central and thin peripheral channels are sealed at epicardial is called the circulatory system, similar to the existing natural (see Fig. 4).Note that the implementation of intersecting channels in the myocardium according to the proposed device for laser effects on the myocardium is quite simple. For this it is necessary by means of a lens or mirror lens to focus the light beam from several or even dozens of parallel beams emitted from a multi-channel laser. Such lasers are well known, for example multi-channel powerful CO2laser MT-2 with 61 channel.However, in this, the simplest case (Fig. 1), each of the component beam 1 is focused in the same plane, the beam 4 as a whole. However, in order to ensure the tapping channel maximum depth, it is necessary to focus each of the component beam on the outer epicardial surface of the myocardium, even if a common point of convergence of all beams lies in the thickness of the myocardium (Fig. 2) or endocardial surface (Fig. 3). Therefore, it is necessary to carry out separate focusing of each composite beam and, in addition, the total beam.Device for influencing the myocardium using laser radiation as follows (Fig. 2).Multichannel, LAZ is therefore located parts 2 and 3 with the possibility of changing the distance between them, and part 2 is removable multi-segment lens or mirror system, each segment which focuses each beam separately, and the other part 3 focuses the entire system bundles in General.Device for influencing the myocardium using laser radiation works as follows.Each beam 1 multichannel laser focuses consistently multi-segment lens system 2 and the total lens 3. When changing the distance between the multi-segment lens system 2 and the total lens 3 is changed and the distance between the point of intersection of the beams 4 and the focus points of each beam 7. In order to form a straight, narrow hole - channels you want the plane of focus of each beam to combine with the epicardial surface of the heart.Literature
1. G. Rudco, Lee Hibbs. Fundamentals of TMR and the Heart Laser, TMR Clinical Reports, PLC Medical Systems Inc., Milford, Ma.2. O. K., countries, etc. the Use of lasers in revascularization of the myocardium, in proceedings of Lasers in surgery, edited by O. K. Sobakina. - M.: Medicine, 1989, S. 230-238. Device for influencing the myocardium by means of laser radiation, including laser installation, articulated manipulator, fokusirovannyi light beams, and the focusing system consists of two consecutive parts with the possibility of changing the distance between them, one of these parts is removable multi-segment lens or mirror system, each segment which focuses the light beams separately, and the other part focuses the entire system bundles in General.
FIELD: medicine, otorhinolaryngological surgery.
SUBSTANCE: one should apply thin layer of "Solcoseryl" gel onto osseous facial walls of frontal and maxillary sinuses at the border with trepanation opening after removing pathological content out of them and before applying a transplant out of flat bone of human fetal cranial arch that exceeds the diameter of trepanation opening by 3-4 mm. Then, one should additionally fix the transplant by affecting with distal edge part of a light guide of semi-conductor laser "ATKUS-15" with contact-type technique at output power of laser radiation being 8 W at constant mode. The method enables to increase fixation density of allobrefobone to osseous walls of sinus along its whole diameter.
EFFECT: higher efficiency of fixation.