BACKGROUND Transmyocardial laser revascularization (TMR) has been shown to improve refractory angina not amenable to conventional coronary interventions. However, the mechanism of action remains controversial, because improved myocardial perfusion has not been consistently demonstrated. We hypothesized that TMR relieves angina by causing myocardial sympathetic denervation. METHODS AND RESULTS...

Transmyocardial revascularization (TMR) is performed via a thoracotomy, with the patient under general anesthesia. Cardiopulmonary bypass is not required. A laser probe is placed on the surface of the myocardium, and while the heart is in diastole, the laser is discharged to create a channel through the myocardium into the left ventricle. Less invasive approaches to TMR are also being studied. ...

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A62-year-old Brazilian white woman with a history of diabetes mellitus had undergone coronary artery bypass grafting to the left anterior descending coronary artery and right coronary artery in 1991. Four years later, she developed recurrent symptoms of angina; angiography revealed occlusion of both saphenous vein grafts. Her native circumflex system remained patent, but her native left anterio...

AIMS Apart from casuistic autopsy results there is no long-term evidence for channel perfusion after transmyocardial laser revascularization in humans. METHODS AND RESULTS Fifteen consecutive patients aged 63+/-17 years were investigated 71+/-15 days after coronary artery bypass surgery and/or transmyocardial revascularization with 13-37 (20+/-5) channels (CO(2) laser, 40 J/pulse). Echocardio...