• B Lauer, F Stahl, U Junghans, R Kluge, and G Schuler.
• Klinik für Innere Medizin/Kardiologie, Universität Leipzig, Herzzentrum GmbH. laub@server3.medizin.uni-leipzig.de
• Dtsch. Med. Wochenschr. 2000 Mar 31; 125 (13): 377-82.

Background And ObjectivesIn patients with intractable angina because of end-stage coronary artery disease, transmyocardial laser revascularization (TMR) leads to improvement of angina pectoris and increased exercise capacity. However, surgical thoracotomy is required for TMR with considerable morbidity and mortality. Therefore, a catheter-based laser system has been developed which allows to create laser channels into the myocardium from the left ventricular cavity.Patients And Methods46 patients (38 m, 8 f) with refractory angina pectoris due to severe coronary artery disease were treated with "percutaneous myocardial laser revascularisation" (PMR). Clinical parameters (severity of angina pectoris, use of additional nitroglycerin) and results of non-invasive tests (exercise-ECG, echocardiography, thallium-scintigraphy) were analysed at baseline and 3, 6 and 12 months after PMR.ResultsThe PMR procedure was successfully completed in all patients. In 30 patients, one region (anterior, lateral, inferior) of the left ventricle was treated and in 16 patients, 2 or 3 regions were treated. Clinical follow-up demonstrated significant improvement of angina pectoris (CCS-class at baseline: 3.1 +/- 0.2, 3 months after PMR: 1.8 +/- 0.7, 12 months after PMR: 1.5 +/- 0.9) (p < 0.001) and increased exercise capacity (exercise time on standard bicycle ergometry at baseline: 383 +/- 151 s, 3 months after PMR: 494 +/- 140 s, 12 months after PMR: 480 +/- 151 s) (p < 0.05), but thallium scintigraphy failed to show improved perfusion of the laser treated regions.ConclusionsPMR is a new safe and feasible therapeutic option in patients with refractory angina pectoris due to end-stage coronary artery disease. Initial results show significant improvement of clinical symptoms and an increased exercise capacity but thallium scintigraphy failed to show improved perfusion after PMR.

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