Transmyocardial Revascularization

What is TMR (Transmyocardial Revascularization)?
Transmyocardial Revascularization (TMR) is a surgical procedure performed in the treatment of stable angina that cannot be treated with medication. TMR is used as a treatment only if conventional treatments like angioplasty or bypass surgery cannot be performed. Laser is used during the procedure to make channels in the left ventricle of the heart.

How is TMR Performed?
An antibacterial solution is applied on the left side of the chest.
A sedative is given through an intravenous line.
Electrocardiogram is performed to monitor the heart rate and blood pressure.
Once the anesthesia is administered, an incision is made on the left side of the chest.
Channels of about one millimeter in size are made in the left ventricle with the help of a special laser.
Bleeding of the channels is stopped by pressing on them gently.

How to Prepare for TMR?
The patient's medical condition is reviewed by the doctor.
Cardiac catheterization is performed to view the coronary arteries and any blockages.
Echocardiogram is performed.
Positron Emission Tomography (PET) is performed to evaluate the function of the heart.
Other tests like Dobutamine Echocardiography and Cardiac MRI are also performed.

How much time is required?
The procedure requires 1 to 2 hours and the hospital stay is for about 4 to 7 days

What type of anesthesia will be given?
General Anesthesia

How will patient recover?
- A complete recovery may take about three months.
- Some patient may experience immediate relief after TMR.
- The patient may still be required to take medications after TMR to improve blood flow.

What should be cared?
- The patient should refrain from strenuous activities.
- Specific activity guidelines are given to the patient.
- The patient may need to undergo a cardiac rehabilitation program to help in recovery.
- The patient needs to meet the cardiologist frequently for follow up visits to monitor the progress after the TMR.