therapeutic effect of transmyocardial laser revascularization (tmlr) in patients with chest pain and normal coronary angiography (cardiac syndrome x)

patients with syndrome x coronary disease represent a heterogeneous group of patients. medical treatment with dilators and calcium channel blockers are not very effective. we evaluated the use of transmyocardial laser revascularization (tmlr) in treating 5 patients with this syndrome. between may 2002 to december 2005, 5 patients with cardiac syndrome x (mean age of 49.7 years) underwent tmlr. all our cases were postmenopausal women. mean class of canadian class of angina was 3.4. patients were none responding to maximum medical treatment. angiograms showed small coronary arties with a large gap between branches which corresponded with severe ischemic on thallium scan. we used co2 laser between 35 to 45 joules of energy and we made 20 to 30 channels on the beating heart controlled by trans-esophagus echocardiography. our patients were followed for 2.8 years. during follow up our patients remained asymptomatic and without any need medical treatment. mean of canadian class of angina after intervention was 1.8. our patients returned to full activities. tmlr is an effective treatment in patients with syndrome x and coronary insufficiency.