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    Laser Treatment Offers Hope for Hopeless Heart Problems

    People with severe, persistent angina (chest pain) and limited treatment options may receive new hope, say researchers from the Texas Heart Institute in Houston. They spoke at the 49th annual meeting of the American College of Cardiology in Anaheim, Calif., that runs through March 15.

    Percutaneous transmyocardial revascularization (PTMR), a procedure in which a flexible catheter with a laser tip is threaded through the vessels in the leg and up into the chambers of the heart, may offer new hope. Once in the ventricle, the cardiologist fires the laser 12 to 26 times to bore several 3-millimeter-long channels into the heart muscle.

    The laser treatment was tested in a study that involved 163 patients with severe chest pain who underwent PTMR at 1 of 20 sites in the United States. The goal was to see if the patients could perform more activity during an exercise test after the procedure than they could before, and to compare their results with 162 patients who were treated with drugs.

    Of those who underwent PTMR once, 55 percent indicated that their angina had "decreased significantly" one year after the procedure. The patients treated with PTMR could withstand exercise longer than those treated with drugs.

    "We are very encouraged by these results," said Emerson Perin, M.D., of the heart institute. "This relatively low-risk procedure shows great promise for those patients with no options who continue to suffer despite traditional therapies."

    Patients who were accepted for the study suffered from Class III or Class IV angina. Many had already had bypass surgeries and angioplasties, and had multiple problems including degenerating grafts, diabetes, high cholesterol and other cardiac risk factors.


    "These are people who are severely disabled," Dr. Perin noted. "They are in so much pain they can't get out of bed, and there is a limit to how much medicine you can give."

    Doctors aren't sure why PTMR helps relieve angina, but they have several theories. One is that the nerve endings in the heart muscle are traumatized and no longer send pain signals. Another is related to the 15 to 20 tiny channels created in the heart muscle by the laser. As these channels heal, they may promote the development of new blood vessels, which will provide oxygen to the heart muscle.

    There are about 200,000 people in the United States for whom severe, continuous angina is a problem and for whom there are no other options.



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