- What Is TMR?
- How TMR Works
- Required Tests
Transmyocardial laser revascularization (TMR or TMLR) is a procedure used to improve the flow of oxygen-rich blood to the heart muscle. It reduces the effects of angina (chest pain), a symptom of coronary artery disease.
The heart needs oxygen-rich blood to survive, which the coronary arteries deliver. Coronary artery disease causes clogged coronary arteries, resulting in decreased blood flow to the heart. A lack of oxygen-rich blood to the heart leads to ischemia, increasing the risk of angina and heart attack.
People who have coronary artery disease are treated with either medication, angioplasty, stenting, or coronary artery bypass surgery to enhance blood flow to the heart muscle. Some may remain symptomatic, such as angina, even after conventional therapies have been exhausted. TMR is often the safest and most effective alternative for such people.
What is transmyocardial laser revascularization?
Transmyocardial laser revascularization (TMR) is a type of surgery that uses a laser to make tiny channels through the heart muscle into the lower-left chamber of the heart to improve oxygen-rich blood flow.
TMR can do the following:
- Improve myocardial oxygenation
- Eliminate or reduce angina
- Improve the cardiovascular function
- Relieve chest pain
- Improve the quality of life
- Reduce the frequency of hospital admissions
How does transmyocardial laser revascularization work?
Transmyocardial laser revascularization is based on the use of a high-powered carbon dioxide laser. The laser interjects a strong energy pulse into the left ventricle, vaporizing the ventricular muscle and creating a transmural channel with a 1-mm diameter.
- This eventually improves the blood flow to the heart.
- The tiny channels act as bloodlines. The pumping of the ventricle sends oxygen-rich blood through these channels, restoring blood flow to the heart muscle.
- The procedure promotes angiogenesis (the growth of new capillaries or blood vessels that help supply blood to the heart muscle).
What are the indications for transmyocardial laser revascularization?
Although coronary artery bypass grafting is effective in most people, transmyocardial laser revascularization (TMR) is a treatment option for:
- Severe angina (that limits daily activities or causes sleep disruption despite medications)
- Ischemia (decreased blood supply to the heart muscle), which is identified using nuclear perfusion scan
- Coronary artery disease, which does respond to or is not eligible for other traditional procedures
- People with a history of bypass surgery or angioplasty
TMR is contraindicated for people with:
- Severely damaged heart muscle is due to heart attacks
- No areas of ischemia in the heart muscle
- Infarcted or scarred heart tissues
- Severe adhesions due to prior coronary artery bypass surgery
What tests determine the need for transmyocardial laser revascularization?
Apart from a thorough medical history and physical examination, tests required before transmyocardial laser revascularization include:
How is a transmyocardial laser revascularization performed?
Before the procedure
- Let your cardiologist know all medications including prescription, over-the-counter, and supplements that you are taking.
- You may undergo certain tests, such as an electrocardiogram, blood tests, urine tests, and a chest X-ray, to analyze your current health condition.
- Avoid smoking at least two weeks before the surgery, which may help reduce the risk of excessive bleeding.
- Do not eat or drink anything after midnight the night before the surgery.
During the procedure
- An electrocardiogram machine monitors your heart’s rhythm and electrical activity. It is attached to your chest through small metal disks called electrodes.
- An intravenous line is established to administer anesthesia during surgery.
- A mild tranquilizer is administered to help you relax before entering the operating room.
- After you are completely asleep, a tube is inserted down the trachea and connected to a respirator, which will allow breathing.
- Another tube is inserted through the nose and throat and into your stomach to stop liquid and air from collecting in the stomach.
- The surgeon makes an incision in the left side of the chest to access the left ventricle and uses a special carbon dioxide laser to make 20 to 40 tiny channels (1 mm wide) in the heart muscle to achieve complete blood flow to the heart.
- The entire transmyocardial laser revascularization procedure typically takes about two hours.
After the procedure
- Stay in the hospital for four to seven days.
- Rest and limit your activities for at least four to six weeks.
- Though the symptoms of coronary artery disease and angina get better, it may take three months or more for complete improvement.
Transmyocardial Laser Revascularization. https://emedicine.medscape.com/article/428355-overview
Transmyocardial Laser Revascularization. https://www.texasheart.org/heart-health/heart-information-center/topics/transmyocardial-laser-revascularization/
TRANSMYOCARDIAL LASER REVASCULARIZATION. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4224272/
The Current Role of TMR in the Treatment of Angina. https://www.acc.org/latest-in-cardiology/articles/2015/10/07/13/42/the-current-role-of-tmr-in-the-treatment-of-angina
Top Transmyocardial Laser Revascularization (TMR) Related Articles
Angina: Signs, Symptoms, and What It Feels LikeAngina is chest pain due to inadequate blood supply to the heart. Angina symptoms may include chest tightness, burning, squeezing, and aching. Coronary artery disease is the main cause of angina but there are other causes. Angina is diagnosed by taking the patient's medical history and performing tests such as an electrocardiogram (EKG), blood test, stress test, echocardiogram, cardiac CT scan, and heart catheterization. Treatment of angina usually includes lifestyle modification, medication, and sometimes, surgery. The risk of angina can be reduced by following a heart healthy lifestyle.
How Is Coronary Heart Disease Diagosed?Coronary heart disease or coronary artery disease (CAD) screening tests can be used to potentially prevent a heart attack or cardiac event in a person without heart disease symptoms, and can assist in diagnosing heart disease in individuals with heart disease symptoms. Coronary heart disease tests can include electrocardiogram (ECC, EKG), exercise stress test, radionuclide stress test, stress echocardiography, pharmacologic stress test, CT coronary angiogram, and coronary angiogram.
Foods That Are Bad for Your HeartIf you want a healthy ticker, there are some foods you’ll want to indulge in every now and then only. Find out which ones and how to make healthy substitutes.
Heart Attack (Myocardial Infarction): Early Warning Signs, Symptoms, Causes, and TreatmentA heart attack occurs when a blood clot completely obstructs a coronary artery supplying blood to the heart muscle. Learn about warning signs, causes, complications, risk factors, and treatment.
Heart Disease: Warning Signs of Cardiovascular Disease
Heart disease (coronary artery disease) occurs when plaque builds up in the coronary arteries, the vessels that supply blood to the heart. Heart disease can lead to heart attack. Risk factors for heart disease include:
- High blood pressure
- High cholesterol
- Family history
Angina, shortness of breath, and sweating are just a few symptoms that may indicate a heart attack. Treatment of heart disease involves control of heart disease risk factors through lifestyle changes, medications, and/or stenting or bypass surgery. Heart disease can be prevented by controlling heart disease risk factors.
Heart Disease in WomenHeart disease in women has somewhat different symptoms, risk factors, and treatment compared to heart disease in men. Many women and health professionals are not aware of the risk factors for heart disease in women and may delay diagnosis and treatment. Lifestyle factors such as diet, exercise, tobacco use, overweight/obesity, stress, alcohol consumption, and depression influence heart disease risk in women. High blood pressure, high cholesterol, and diabetes also increase women's risk of heart disease. Electrocardiogram (EKG or ECG), stress-ECG, endothelial testing, ankle-brachial index (ABI), echocardiogram, nuclear imaging, electron beam CT, and lab tests to assess blood lipids and biomarkers of inflammation are used to diagnose heart disease. Early diagnosis and treatment of heart disease in women saves lives. Heart disease can be prevented and reversed with lifestyle changes.
CAD SlideshowWhat is heart disease (coronary artery disease)? Learn about the causes of heart disease, arrhythmias and myopathy. Symptoms of heart disease include chest pain and shortness of breath. Explore heart disease diagnosis, treatment, and prevention.
Heart Disease: Causes of a Heart AttackHeart disease prevention includes controlling risk factors like diet, exercise, and stress. Heart disease symptoms in women may differ from men. Use a heart disease risk calculator to determine your heart attack risk.
Heart Disease QuizTake our Heart Disease Quiz to get answers and facts about high cholesterol, atherosclerosis prevention, and the causes, symptoms, treatments, testing, and procedures for medically broken hearts.
Heart Failure: Causes, Signs, Stages, and TreatmentHeart failure (congestive) is caused by many conditions including coronary artery disease, heart attack, cardiomyopathy, and conditions that overwork the heart. Symptoms of heart failure include congested lungs, fluid and water retention, dizziness, fatigue and weakness, and rapid or irregular heartbeats. There are two types of congestive heart failure, systolic or left-sided heart failure; and diastolic or right-sided heart failure. Treatment, prognosis, and life-expectancy for a person with congestive heart failure depends upon the stage of the disease.
How Is Coronary Artery Bypass Graft Performed?Coronary artery bypass grafting (CABG) is a surgery performed in patients with coronary artery disease (CAD). Coronary artery bypass grafting (CABG) is a surgery that helps create adequate blood flow to the heart by using healthy blood vessels harvested from some other sites (e.g., leg, arm or chest) to bypass the flow of blood from the site of the blockage. Complications include bleeding, irregular heartbeat, heart attack, stroke, kidney failure, cardiac tamponade, infections, and injury to blood vessels.
How Much Does Treatment for Heart Disease Cost?Treatment costs for heart disease depend on the type of treatment, doctors, hospitals, and insurance plans. The cost could be a couple of hundred dollars for medication and $20,000 (USD) for surgery.
Heart Disease: How to Help Prevent an AFib AttackThese simple things can make a flare-up of atrial fibrillation less likely.
What Are the Fastest Ways to Treat Angina?Learn what medical treatments can help ease your angina symptoms and speed up your recover.
What Can I Do to Relieve Angina Pain?Learn what medical treatments can help ease your angina pain symptoms and help you manage this condition.