Transmyocardial laser revascularization (TMLR): a long way to the first successful clinical application in the world.

Much attention has been paid to surgical intervention for those patients with small branches or diffuse stenotic lesions of the coronary arteries, for whom coronary artery bypass grafting can not be carried out at all. For resolving these problems, we have planned to supply arterial blood from the left ventricular cavity into the ischemic myocardium through laser channels created by laser into the myocardium. It was obviously recognized that arterial blood could be hemodynamically supplied from the left ventricular cavity into the ischemic myocardium. In trials on dogs, laser channels 0.2 mm in diameter have been shown microscopically to be patent even 3 years after TMLR. Thus, this procedure could be used as a new method of transmyocardial revascularization. Subsequently, TMLR was applied in a 55-year-old male patient with severe angina pectoris who had undergone pericardiectomy 7 years before. He is still alive 12 years after TMLR. This patient was the first successful clinical case treated by TMLR alone, in the world.