Drilling holes in the heart helps angina

Transmyocardial revascularisation, a controversial procedure in which a laser is used to drill tiny holes into the heart, provides symptomatic relief from refractory angina but does not improve cardiovascular function or reduce adverse ischaemic events, according to a new report (Journal of the American College of Cardiology 2000:35:1170-7).

The procedure, in which a laser is used to drill 30-50 holes into a beating ventricle, received provisional approval for refractory angina by the Food and Drug Administration in May 1998. About 5000 patients worldwide have undergone the procedure.

It was developed to provide an alternative route for blood to reach ischaemic myocardium. Typically, …