Experimental and clinical studies on transmyocardial laser revascularization (TMLR)

The number of patients with coronary artery disease has been increasing and several kinds of treatments have been performed to alleviate their conditions. In patients with small branches or diffuse stenotic lesions of the coronary arteries, on whom coronary artery bypass grafting and intracoronary intervention cannot be carried out, it has been shown possible to supply arterial blood from the left ventricular cavity to the ischemic myocardium through laser channels. Arterial blood can be supplied hemodynamically from the left ventricular cavity to the ischemic myocardium. In trials on dogs laser channels 0.2 mm in diameter have been found to be histologically patent even 3 years after transmyocardial laser revascularization (TMLR). Thus, this procedure could be used as an alternative method of transmyocardial revascularization. We used TMLR on a 55-year-old male patient with severe angina pectoris who had undergone pericardiectomy 7 years ago. He is still alive more than 12 years after TMLR. This patient was among the first successful clinical cases in the world treated by TMLR alone. Therefore, this procedure should be recommended for the patients with end-stage coronary artery disease.