title: Use of magnetic resonance imaging to assess myocardial perfusion after transmyocardial laser revascularization.
abstract: BACKGROUND
  Transmyocardial laser revascularization (TMLR) is an alternative treatment modality for patients with refractory angina who are not candidates for conventional surgical or percutaneous revascularization. Clinical studies of TMLR have not shown one-to-one correlation between increased myocardial perfusion and improved clinical status.
  
  
  METHODS
  Three patients (51, 53, and 70 years old) with severe, diffuse coronary artery disease not amenable to conventional surgical revascularization and with angina (Canadian Cardiovascular Society [CCS] class 3-4) refractory to maximal medical therapy underwent TMLR with a CO2 laser. Preoperative and postoperative cardiac magnetic resonance imaging (MRI) were performed to assess left ventricular perfusion and wall-motion changes in the laser-treated areas. Postoperative MRIs were performed within 6 months of TMLR and at 12 months. Angina status was assessed with the Seattle Angina Questionnaire.
  
  
  RESULTS
  Postoperative adenosine stress myocardial perfusion imaging with MRI revealed improved overall perfusion and a reduction in subendocardial hypoperfused areas when compared to preoperative images. In all patients, an improvement in CCS class was consistent with an improvement in perfusion.
  
  
  CONCLUSIONS
  Cardiac MRI can be used to assess improved subendocardial perfusion after TMLR treatment. In our study, we found that endocardial perfusion was maintained over a 12-month period.
authors.affiliation: Department of Diagnostic Radiology, Texas Heart Institute, Houston, TX 77225-0345, USA.
authors.forename: Mehmet H
authors.initials: MH
authors.lastname: Akay
authors.forename: Benjamin Y
authors.initials: BY
authors.lastname: Cheong
authors.forename: O H
authors.initials: OH
authors.lastname: Frazier
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D055420:Perfusion Imaging / Q000379:methods; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis* / Q000517:prevention & control*