[Transmyocardial laser treatment--a new treatment modality in pronounced angina pectoris?]

Transmyocardial laser treatment is currently being evaluated as a treatment modality for patients with severe coronary artery disease unsuitable for conventional revascularization with percutaneous transluminal coronary angioplasty or coronary artery bypass grafting. The original hypothesis was that laser-made channels could contribute to myocardial perfusion by conducting blood from the left ventricular cavity into the ischemic myocardium. Results from clinical trials suggest that transmyocardial laser treatment leads to a significant decrease in physician-assessed angina scores and improvement of quality of life. There are, however, conflicting data regarding the effect of myocardial perfusion, and the mechanisms responsible for the observed clinical effect remain unclear. It has been suggested that the angina relief is caused by destruction of myocardial peripheral nerve-endings and improved perfusion through induction of angiogenesis and collateral recruitment. A review of transmyocardial laser treatment with emphasis on experimental and clinical results, based on a thoroughly performed search on Medline of English language publications up until May 1999, is presented.