Background:Trans myocardial laser revascularization was used as the sole therapy for patients with ischemic heart disease not amenable to percutaneous translational coronary angioplasty or coronary artery bypass grafting. This technique uses a carbon dioxide laser to create Tran myocardial channels for direct perfusion of the ischemic heart.Methods: form 1999, to 2003 (50) patients, have undergone Tran myocardial laser revascularization. The patients their ejection fraction was 47 % + 12 %. Preoperatively, the patients underwent nuclear single photon emission computed tomography perfusion scans to identify the extent and severity of their ischemia. These scans were repeated at 3. 6. months. Angina class, admissions for angina, and medications war recorded. Results and conclusion: the perioperative mortality was 6%. Angina class decreased significantly from before treatment to 3. 6. months. Likewise, there was a significant decrease in the number of perfusion defects in the treated left ventricular free wall. Concomitantly, there was a significant decrease in the number of admissions for angina.