To the Editor:
It was with great interest that I read the recent article on Profulla Kumar Sen's contributions to cardiovascular surgery, 1 because I had the chance to meet P.K. Sen in Bombay in 1969 and to participate, with G.B. Parulkar, in his experimental work on transmyocardial acupuncture. This occurred while I was a resident in the department of surgery (head, Prof. H.G. Borst) at Hannover Medical School.
When I returned to my department, I did a series of experiments with canine models to investigate the effectiveness of this method. After creating punctures using the cannula diameter that Dr. Sen had recommended, we measured the myocardial blood flow with 86Rb-chloride in the infarcted area and found no increase in flow. We then created channels by using a larger (4-mm) cannula.
To avoid bleeding or the necessity of suturing an opening in the epicardium, we used the following technique. The 4-mm cannula entered the left ventricular cavity from the posterior wall and penetrated the ischemic myocardium through the endocardium, without perforating the epicardium. Myocardial cylinders were removed by gently pulling back the cannula, the lumen of which was under negative pressure. This variation of the technique resulted in a significant increase in blood flow to the infarcted area (from 4.43% to 14.93%, p <0.05), in experiments with both acute and chronic myocardial ischemia. 2–5
These results demonstrated that a certain inner diameter (4 mm) of the cannula was needed to significantly increase the nutritional blood flow to the ischemic myocardium. In the new technique of “transmyocardial laser revascularization,” the channels created by the conventional laser beam are comparable in size to those produced by the small Sen puncture-needles (1.2–1.4 mm), which were shown by our experiments to be ineffective. If channels of 4 mm could be created by a laser or by some other means, a significant increase in flow could probably be produced.
During my visit to Bombay, Dr. Sen was kind enough to give me one of his oil paintings, which is still in my possession. I am very grateful for the time that I spent with him.
References
- 1.Mittal CM. Profulla Kumar Sen: his contributions to cardiovascular surgery. Tex Heart Inst J 2002;29:17–25. [PMC free article] [PubMed]
- 2.Walter P. Transmyocardial revascularization of the left ventricle by acupuncture [abstract]. In: Kaltenbach M, Lichtlen P, editors. Coronary heart disease. International Symposium in Frankfurt; 1970 Jan 22–24; Frankfurt, Germany. Stuttgart: Georg Thieme Verlag; 1971. p. 264–5.
- 3.Walter P, Hundeshagen H, Borst HG. Blood-supply of infarcted myocardium from the left ventricular cavity [abstract]. Br J Surg 1971;58:308. [PubMed]
- 4.Walter P, Hundeshagen H, Borst HG. Treatment of acute myocardial infarction by transmural blood supply from the ventricular cavity. Eur Surg Res 1971;3:130–8. [DOI] [PubMed]
- 5.Walter P, Lamprecht W, Hundeshagen H, Borst HG. Myocardial blood flow and alterations of LDH isoenzymes in infarcted heart muscle and after transmural punctures. Cardiology 1971;56:371–6. [DOI] [PubMed]