The use of carbon dioxide fiberoptic laser catheter for atrial septostomy

The development of optical fibers capable of transmitting laser energy has encouraged the experimental use of laser irradiation for the treatment of acquired cardiovascular disorders. One of the key questions is which combination of laser source, energy parameters, and transmitting fiberoptic would be best suited for intravascular use. In most experiments argon, neodymium-YAG, and excimer lasers, coupled to suitable optical fibers, have been used. We now describe the use of a carbon dioxide fiberoptic laser catheter for the creation of an atrial septal defect. Silver halide infrared transmitting fibers were inserted into standard 6 French cardiovascular catheters. This laser catheter system, capable of transmitting several watts of pulsed CO₂ laser energy, was initially used to create atrial septal defects in isolated dog hearts to determine the best energy parameters. Atrial septostomy was later performed successfully in four of five anesthetized dogs. The thermal damage extended 50 to 60 μm beyond the "holes" created by the laser irradiation in the interatrial septum. Thus, pulsed CO₂ laser irradiation, delivered through optical fibers, can create an atrial septal defect.